Management of complex pediatric and adolescent liver trauma: adult vs pediatric level 1 trauma centers
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In brief
In brief
This retrospective study compares management approaches for high-grade liver injuries in pediatric and adolescent patients between adult and pediatric level 1 trauma centers. Adult centers utilized interventional radiology and operative management more frequently, while pediatric centers successfully managed over 95% of cases non-operatively despite lower injury severity scores.
- Adult trauma centers used interventional radiology 10x more often than pediatric centers for high-grade liver injuries (51.9% vs 4.8%).
- Pediatric trauma centers successfully managed >95% of Grade 4/5 liver injuries non-operatively despite lower IR utilization.
- Adult trauma centers treated older patients with higher injury severity scores and more penetrating trauma compared to pediatric centers.
- Operative management rates were higher at adult centers (26.7% vs 11.0%), but mortality and length of stay were similar between center types.
- Optimal management algorithms for older adolescents with complex liver trauma remain unclear and require prospective study.
Written by the GCMD Library team from the article.
Abstract
Purpose
Management of high-grade pediatric and adolescent liver trauma can be complex. Studies suggest that variation exists at adult (ATC) vs pediatric trauma centers (PTC); however, there is limited granular comparative data. We sought to describe and compare the management and outcomes of complex pediatric and adolescent liver trauma between a level 1 ATC and two PTCs in a large metropolitan city.
Methods
A retrospective review of pediatric and adolescent (age < 21 years) patients with American Association for the Surgery of Trauma (AAST) Grade 4 and 5 liver injuries managed at an ATC and PTCs between 2016 and 2022 was performed. Demographic, clinical, and outcome data were obtained at the ATC and PTCs. Primary outcomes included rates of operative management and use of interventional radiology (IR). Secondary outcomes included packed red blood cell (pRBC) utilization, intensive care unit (ICU) length of stay (LOS), and hospital LOS.
Results
One hundred forty-four patients were identified, seventy-five at the ATC and sixty-nine at the PTC. The cohort was predominantly black (65.5%) males (63.5%). Six injuries (8.7%) at the PTC and forty-five (60%) injuries at the ATC were penetrating trauma. Comparing only blunt trauma, ATC patients had higher Injury Severity Score (median 37 vs 26) and ages (20 years vs 9 years). ATC patients were more likely to undergo operative management (26.7% vs 11.0%, p = 0.016) and utilized IR more (51.9% vs 4.8%, p < 0.001) compared to the PTC. The patients managed at the ATC required higher rates of pRBC transfusions though not statistically significant (p = 0.06). There were no differences in mortality, ICU, or hospital LOS.
Conclusion
Our retrospective review of high-grade pediatric and adolescent liver trauma demonstrated higher rates of IR and operating room use at the ATC compared to the PTC in the setting of higher Injury Severity Score and age. While the PTC successfully managed > 95% of Grade 4/5 liver injuries non-operatively, prospective data are needed to determine the optimal algorithm for management in the older adolescent population.
Level of evidence
Level IV.