Nonoperative management of pediatric blunt hepatic trauma

The purpose of this study was to examine the effect of operative versus non operative management of blunt hepatic trauma in children including transfus ion practices. We reviewed the experience at our American College of Surgeo ns-verified Level I trauma center with pediatric commitment over a 5-year p eriod. Children less than or equal to 16 years of age suffering blunt liver injury as documented on admission CT scan were included in the study. Live r injuries identified on CT scan were classified according to the American Association for the Surgery of Trauma's Organ Injury Scaling system. All da ta are presented as mean +/- standard error. One case of pediatric liver tr auma not identified on CT was excluded (prehospital cardiopulmonary resusci tation). Twenty-seven patients were included [age 9.3 +/- 1.0 years (range 3-16)]. Mechanisms of injury included motor vehicle crash (14), pedestrian struck by motor vehicle (7), bicycle crash (4), fall from height (1), and p edestrian struck by falling object (1). Trauma Score was 11.5 +/- 0.3. Dist ribution of Liver Injury Grade was as follows: grade I, 13; grade II, 9; gr ade III, 3; grade IV, 2; and grade V, 0. All five patients who underwent op erative management had multiple organ injuries; three had concomitant splen ic injury requiring operative repair; the remaining two had small bowel inj ury requiring repair. Hepatorrhaphy did not correlate with severity of live r injury: grade I, n = 1; II, n = 2; III, n = 1; and IV, n = 1. Three opera ted patients received blood transfusions. Twenty-two patients were managed with nonoperative treatment, of these only one required blood transfusion. No patients in the study died, three were transferred to subacute rehabilit ation, one was transferred to another hospital, and 23 were discharged home . Our findings indicate that a majority of children with blunt hepatic inju ry as documented on CT scan can be managed with nonoperative treatment, and few require blood transfusions. Patients with multiple organ injury includ ing simultaneous splenic injury are likely ideally managed through operativ e exploration and repair, whereas those with isolated liver injuries can be successfully managed nonoperatively.