J Hamill1, R Paice, I Civil, A Kolbe. 1. Trauma Services, Auckland Hospital and Starship Children's Hospital, New Zealand. hamill@clear.net.nz
Abstract
BACKGROUND: In order to identify differences between children and adults with small bowel rupture (SBR) and to determine if a single diagnostic approach could be taught to paediatric and adult surgeons, a review of the experience at a children's and an adults' hospital was performed. METHODS: Using the hospital patient database 17 children were identified with SBR over a 13.6-year period, and clinical records were available for review for 14. Using a trauma registry 16 adults were identified with SBR over a 4.7-year period and clinical records were reviewed in all 16. RESULTS: The population incidence was 0.48/100000 per annum in children and 0.58/100000 per annum in adults. Motor vehicle crash was a less common mechanism of injury in children (35.7%) than in adults (75%). The time from injury to presentation (presentation interval) was significantly longer in children than in adults, even after excluding child abuse cases (median 2.9 h vs 65 min, respectively). The injury severity score was lower in children (median: 10) than in adults (median: 16.5). Peritoneal signs on follow-up examination were documented in 54.6% of children and in 90.9% of adults in whom follow-up examination was performed. Clinical findings on admission, findings on computed tomography, indications for operation and outcome were similar in children and adults. CONCLUSION: Children differed from adults in aetiology, longer presentation interval and fewer associated injuries. Similarities in diagnostic parameters suggest that a single diagnostic approach could be taught for children and adults provided that the limitations of physical examination in small children are recognized.
BACKGROUND: In order to identify differences between children and adults with small bowel rupture (SBR) and to determine if a single diagnostic approach could be taught to paediatric and adult surgeons, a review of the experience at a children's and an adults' hospital was performed. METHODS: Using the hospital patient database 17 children were identified with SBR over a 13.6-year period, and clinical records were available for review for 14. Using a trauma registry 16 adults were identified with SBR over a 4.7-year period and clinical records were reviewed in all 16. RESULTS: The population incidence was 0.48/100000 per annum in children and 0.58/100000 per annum in adults. Motor vehicle crash was a less common mechanism of injury in children (35.7%) than in adults (75%). The time from injury to presentation (presentation interval) was significantly longer in children than in adults, even after excluding child abuse cases (median 2.9 h vs 65 min, respectively). The injury severity score was lower in children (median: 10) than in adults (median: 16.5). Peritoneal signs on follow-up examination were documented in 54.6% of children and in 90.9% of adults in whom follow-up examination was performed. Clinical findings on admission, findings on computed tomography, indications for operation and outcome were similar in children and adults. CONCLUSION:Children differed from adults in aetiology, longer presentation interval and fewer associated injuries. Similarities in diagnostic parameters suggest that a single diagnostic approach could be taught for children and adults provided that the limitations of physical examination in small children are recognized.