Solid Organ trauma an Offally good approach Juliette King Department Paediatric surgery Starship

Haggis

Background

1/1/09-31/12/2013  146 patients identified from the prospectively managed trauma database.  10 excluded as did not have injury of Liver, Spleen, Kidney, Pancreas.  44% were direct admissions the rest transferred in

Demographics  Age Mean 9 (1-15)  Sex 74% Male  3 deaths from other injuries

Mechanism

Tests  Elevated transaminases  Decreased haemaglobin  Micro or macroscopic haematuria  Elevated amylase

Ethnicity

Signs and symptoms  Handlebar marks  Bruises over flanks  Unconscious patient  Abdominal tenderness  Seat belt marks  Chest or pelvic injury

Organ Injured

AAST Grading Liver

Grade of Injury

Length of stay

APSA guidelines

Conclusion  Solid organ trauma is common and can have fairly benign seeming mechanisms of injury.  If they are suspected contrast enhanced CT is the imaging of choice  They can usually be managed conservatively following grading by CT  We are still very conservative in our management.  We are looking to creating a guideline for in patient stay.

References  Hynick et al 2013 J Trauma Acute Care Surg Volume 76, Number 1  Stylianos Journal of Pediatric Surgery, Vol 35, No 2 (February), 2000: pp  Aguyau et al Journal of Pediatric Surgery (2010) 45, 1311–1314  Leinwand et al Journal of Pediatric Surgery, Vol 39, No 3 (March), 2004: pp  St Peter et al Journal of Pediatric Surgery (2013) 48, 2437–2441  Yang et al Journal of Pediatric Surgery (2008) 43, 2264–2267