Predicting hollow visceral injury in the pediatric blunt trauma patient with solid visceral injury

Background: Nonoperative management of a solid organ injury (SVI) is accept ed in the stable pediatric trauma patient. A concern with nonoperative mana gement is missing a hollow visceral injury (HVI). Factors that may help pre dict HVI have not been well documented. Methods: The National Pediatric Trauma Registry was reviewed for the period October 1988 through September 1998 for all blunt injured, hemodynamically stable pediatric patients (age less than or equal to 12 years) with an SVI (kidney, liver, pancreas, spleen) of Abbreviated Injury Scale (AIS) score greater than or equal to 2. HVIs included AIS greater than or equal to 2 ga strointestinal tract injuries. Results: For the decade of review, 2,977 pediatric patients sustained an SV I, including 96 with an HVI (3.2%), The mean age was 6.6 years, with a mean Injury Severity Score of 12.4. An occupant in a motor vehicle accident was the most common injury mechanism (30.4%), but assault was the most likely to result in an HVI (11.5%). The liver was the most common SVI (n = 1,400), the spleen the least likely to have an associated HVI (2.5%). Pancreatic i njuries had a higher rate of HVI (P<.001). The majority of patients had a s ingle SVI (n = 2,507) with 71 associated HVIs (2.8%). The risk of associate d HVI increased as the number of solid organs injured increased: 4.7% with 2 organs, 13.5% if 3 organs were injured (P<.001). In patients with a singl e SVI, the rate of HVI did not differ as AIS increased (range, 2.7% to 6.5% , P value not significant). Conclusions: The overall rate of HVI was low (3.2%), Higher rates of HVI we re found in assaulted patients and patients with multiple SVIs or pancreati c injuries. The risk of associated HVI was dependent more on number of SVIs than severity of the individual organ injury. This data suggest that nonop erative management is justified in the patient with a single SVI but should be used cautiously in the patient with multiple SVI or a pancreatic injury . J Pediatr Surg 35:1300-1303. Copyright (C) 2000 by W.B. Saunders Company.