Solid Organ trauma an Offally good approach

Juliette KingDepartment Paediatric surgery

Starship

Haggis

Background

1/1/09-31/12/2013 146 patients identified from the prospectively

managed trauma database. 10 excluded as did not have injury of Liver,

Spleen, Kidney, Pancreas. 44% were direct admissions the rest transferred

in

Demographics Age Mean 9 (1-15) Sex 74% Male 3 deaths from other injuries

Mechanism

BoatingMotor Vehicle-insideMotor Vehicle-outsideSportFall from heightFallNAIHandlebar

Tests Elevated transaminases Decreased haemaglobin Micro or macroscopic haematuria Elevated amylase

Ethnicity

MaoriEuropeanPacific IslandIndianChineseOther

Signs and symptoms Handlebar marks Bruises over flanks Unconscious patient Abdominal tenderness Seat belt marks Chest or pelvic injury

Organ Injured

liverspleenKidneyPancreasMultiple

AAST Grading Liver

http://www.aast.org/library/traumatools/injuryscoringscales.aspx

Grade of Injury

1 2 3 4 50

5

10

15

20

25

LiverSpleenKidney

Length of stay

1 2 3 4 50

2

4

6

8

10

12

14

16

LiverSpleenKidneyAPSA

APSA guidelines

Conclusion Solid organ trauma is common and can have fairly

benign seeming mechanisms of injury. If they are suspected contrast enhanced CT is the

imaging of choice They can usually be managed conservatively

following grading by CT We are still very conservative in our

management. We are looking to creating a guideline for in

patient stay.

References Hynick et al 2013 J Trauma Acute Care Surg Volume 76, Number

1 Stylianos Journal of Pediatric Surgery, Vol 35, No 2 (February),

2000: pp 164-169 Aguyau et al Journal of Pediatric Surgery (2010) 45, 1311–1314 Leinwand et al Journal of Pediatric Surgery, Vol 39, No 3

(March), 2004: pp 487-490 St Peter et al Journal of Pediatric Surgery (2013) 48, 2437–2441 Yang et al Journal of Pediatric Surgery (2008) 43, 2264–2267