NONOPERATIVE MANAGEMENT OF SOLID-ORGAN INJURIES IN CHILDREN - IS IT SAFE

Objective The authors reviewed their experience with life-threatening blunt injuries in approximately 2900 children (0-14 years) admitted to the designated state pediatric shock trauma unit between 1990 and 199 3. Methods During this time, the authors treated all severely injured children with a prospective, nonoperative protocol if they were hemody namically stable after less than 40 mL/kg fluid replacement, had prove n evidence of solid organ injuries and remained stable in the pediatri c intensive care unit under surgical management. Results Twenty-eight children had computed tomography (CT) or operatively proven laceration s of the spleen, 25 had lacerations oi the liver, 18 had lacerations o f the kidney, 7 had lacerations of the pancreas, and 11 had two or mor e solid organ injuries. Three of the 28 children with injured spleens required laparotomy (two splenectomy, one splenorrhaphy). Two of the 2 5 children with liver injuries required laparotomy (one suturing, one partial resection). One oi the 18 children with kidney injuries requir ed laparotomy (nephrectomy), and 3 of the 7 children with pancreas inj uries required laparotomy (two resection, one pseudocyst). There were three deaths after laparotomy (two head, one chest/abdominal). There w ere no deaths in the children managed nonoperatively, and there were n o immediate or long-range complications. Conclusions Comparison of the authors' data with the National Pediatric Trauma Registry shows simil ar results. The authors believe that nonoperative management of solid organ injuries under careful surgical observation in a pediatric inten sive care unit is safe and appropriate.