Robert L Gates1, Mitchell Price2, Danielle B Cameron3, Stig Somme4, Robert Ricca5, Tolulope A Oyetunji6, Yigit S Guner7, Ankush Gosain8, Robert Baird9, Dave R Lal10, Tim Jancelewicz8, Julia Shelton11, Karen A Diefenbach12, Julia Grabowski13, Akemi Kawaguchi14, Roshni Dasgupta15, Cynthia Downard16, Adam Goldin17, John K Petty18, Steven Stylianos19, Regan Williams20. 1. University of South Carolina School of Medicine - Greenville, Greenville, SC. 2. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY. 3. Department of Surgery, Boston Children's Hospital, Boston, MA. 4. Division of Pediatric Surgery, Children's Hospital of Colorado, Aurora, CO. 5. Division of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, VA. 6. University of Missouri - Kansas City School of Medicine, Department of Surgery, Children's Mercy Hospital, Kansas City, MO. 7. University of California - Irvine, Division of Pediatric and Thoracic Surgery, Children's Hospital of Orange County, Irvine, CA. 8. Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN. 9. Department of Pediatric General and Thoracic Surgery, The British Columbia Children's Hospital, Vancouver, BC, Canada. 10. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 11. Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA. 12. Department of Pediatric Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, OH. 13. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL. 14. Department of Pediatric Surgery, McGovern School of Medicine, University of Texas at Houston, Houston, TX. 15. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 16. Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY. 17. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA. 18. Wake Forest University School of Medicine, Childress Institute for Pediatric Trauma, Winston-Salem, NC. 19. Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY. 20. Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN. Electronic address: rfwillia@uthsc.edu.
Abstract
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.
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.
Authors: Sarah C Stokes; Erin G Brown; Jordan E Jackson; David E Leshikar; Jacob T Stephenson Journal: Pediatr Surg Int Date: 2021-03-29 Impact factor: 1.827
Authors: Shenise Gilyard; Kaitlin Shinn; Nariman Nezami; Laura K Findeiss; Sean Dariushnia; April A Grant; C Matthew Hawkins; Gail L Peters; Bill S Majdalany; Janice Newsome; Zachary L Bercu; Nima Kokabi Journal: Semin Intervent Radiol Date: 2020-03-04 Impact factor: 1.513
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165
Authors: Roy Spijkerman; Lauren C M Bulthuis; Lillian Hesselink; Thomas M P Nijdam; Luke P H Leenen; Ivar G J M de Bruin Journal: Eur J Trauma Emerg Surg Date: 2020-02-11 Impact factor: 3.693