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Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre
BACKGROUND: Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complicati...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129239/ https://www.ncbi.nlm.nih.gov/pubmed/27899118 http://dx.doi.org/10.1186/s13049-016-0329-x |
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author | Koyama, Tomohide Skattum, Jorunn Engelsen, Peder Eken, Torsten Gaarder, Christine Naess, Pål Aksel |
author_facet | Koyama, Tomohide Skattum, Jorunn Engelsen, Peder Eken, Torsten Gaarder, Christine Naess, Pål Aksel |
author_sort | Koyama, Tomohide |
collection | PubMed |
description | BACKGROUND: Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. METHODS: Patients <17 years old with liver injury admitted to Oslo University Hospital Ullevaal during the period 2002-2013 were retrospectively reviewed. Data were compiled from the institutional trauma registry and medical records. RESULTS: A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. DISCUSSION: This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. CONCLUSION: NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated. |
format | Online Article Text |
id | pubmed-5129239 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-51292392016-12-12 Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre Koyama, Tomohide Skattum, Jorunn Engelsen, Peder Eken, Torsten Gaarder, Christine Naess, Pål Aksel Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. METHODS: Patients <17 years old with liver injury admitted to Oslo University Hospital Ullevaal during the period 2002-2013 were retrospectively reviewed. Data were compiled from the institutional trauma registry and medical records. RESULTS: A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. DISCUSSION: This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. CONCLUSION: NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated. BioMed Central 2016-11-29 /pmc/articles/PMC5129239/ /pubmed/27899118 http://dx.doi.org/10.1186/s13049-016-0329-x Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Research Koyama, Tomohide Skattum, Jorunn Engelsen, Peder Eken, Torsten Gaarder, Christine Naess, Pål Aksel Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre |
title | Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre |
title_full | Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre |
title_fullStr | Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre |
title_full_unstemmed | Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre |
title_short | Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre |
title_sort | surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major scandinavian trauma centre |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129239/ https://www.ncbi.nlm.nih.gov/pubmed/27899118 http://dx.doi.org/10.1186/s13049-016-0329-x |
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