TY - JOUR
T1 - Non-operative management of solid organ injuries in children
T2 - An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review
AU - Gates, Robert L.
AU - Price, Mitchell
AU - Cameron, Danielle B.
AU - Somme, Stig
AU - Ricca, Robert
AU - Oyetunji, Tolulope A.
AU - Guner, Yigit S.
AU - Gosain, Ankush
AU - Baird, Robert
AU - Lal, Dave R.
AU - Jancelewicz, Tim
AU - Shelton, Julia
AU - Diefenbach, Karen A.
AU - Grabowski, Julia
AU - Kawaguchi, Akemi
AU - Dasgupta, Roshni
AU - Downard, Cynthia
AU - Goldin, Adam
AU - Petty, John K.
AU - Stylianos, Steven
AU - Williams, Regan
N1 - Publisher Copyright:
© 2019
PY - 2019/8
Y1 - 2019/8
N2 - Purpose: The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children. Methods: A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Four principal questions were examined based upon the previously published consensus APSA guidelines regarding length of stay (LOS), activity level, interventional radiologic procedures, and follow-up imaging. A literature search was performed including multiple databases from 1996 to 2016. Results: LOS for children with isolated solid organ injuries should be based upon clinical findings and may not be related to grade of injury. Total LOS may be less than recommended by the previously published APSA guidelines. Restricting activity to grade of injury plus two weeks is safe but shorter periods of activity restriction have not been adequately studied. Prophylactic embolization of SOI in stable patients with image-confirmed arterial extravasation is not indicated and should be reserved for patients with evidence of ongoing bleeding. Routine follow-up imaging for asymptomatic, uncomplicated, low-grade injured children with abdominal blunt trauma is not warranted. Limited data are available to support the need for follow-up imaging for high grade injuries. Conclusion: Based upon review of the recent literature, we recommend an update to the current APSA guidelines that includes: hospital length of stay based on physiology, shorter activity restrictions may be safe, minimizing post-injury imaging for lower injury grades and embolization only in patients with evidence of ongoing hemorrhage. Type of Study: Systematic Review. Levels of Evidence: Levels 2–4.
AB - Purpose: The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children. Methods: A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Four principal questions were examined based upon the previously published consensus APSA guidelines regarding length of stay (LOS), activity level, interventional radiologic procedures, and follow-up imaging. A literature search was performed including multiple databases from 1996 to 2016. Results: LOS for children with isolated solid organ injuries should be based upon clinical findings and may not be related to grade of injury. Total LOS may be less than recommended by the previously published APSA guidelines. Restricting activity to grade of injury plus two weeks is safe but shorter periods of activity restriction have not been adequately studied. Prophylactic embolization of SOI in stable patients with image-confirmed arterial extravasation is not indicated and should be reserved for patients with evidence of ongoing bleeding. Routine follow-up imaging for asymptomatic, uncomplicated, low-grade injured children with abdominal blunt trauma is not warranted. Limited data are available to support the need for follow-up imaging for high grade injuries. Conclusion: Based upon review of the recent literature, we recommend an update to the current APSA guidelines that includes: hospital length of stay based on physiology, shorter activity restrictions may be safe, minimizing post-injury imaging for lower injury grades and embolization only in patients with evidence of ongoing hemorrhage. Type of Study: Systematic Review. Levels of Evidence: Levels 2–4.
KW - Liver injury
KW - Pediatric trauma
KW - Renal injury
KW - Spleen injury
KW - Systematic review
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U2 - 10.1016/j.jpedsurg.2019.01.012
DO - 10.1016/j.jpedsurg.2019.01.012
M3 - Review article
C2 - 30773395
AN - SCOPUS:85061427139
SN - 0022-3468
VL - 54
SP - 1519
EP - 1526
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 8
ER -