PMID- 16246338
OWN - NLM
STAT- MEDLINE
DCOM- 20060530
LR  - 20161124
IS  - 0020-1383 (Print)
IS  - 0020-1383 (Linking)
VI  - 37
IP  - 1
DP  - 2006 Jan
TI  - Liver injuries in children: the role of selective non-operative management.
PG  - 66-71
AB  - INTRODUCTION: This review article on the management of blunt liver injury in 
      children is based on the authors' experience of 311 patients over a 22-year 
      period. MATERIAL AND METHODS: All children presenting to our institution with 
      confirmed blunt liver trauma were studied retrospectively. Hospital folders of 
      311 patients were analysed. Information was gathered about the clinical 
      presentation, associated injuries, grade of injury, transfusion requirements and 
      haemodynamic stability to examine factors influencing outcome. RESULTS: The age 
      of patients ranged between 3 weeks and 12 years (mean of 7 years). Injuries as a 
      result of motor vehicle accidents (MVAs) were the most common (268; 232 
      pedestrian and 36 passenger), other causes were falls (26) assaults or child 
      abuse(15), bicycle handle bar injury (2). One hundred and thirty-six patients 
      sustained an isolated hepatic injury and 175 had multiple injuries. Associated 
      injuries included 147 head injuries, 131 fractures, 66 thoracic and 143 
      intra-abdominal (74 spleen, 45 renal, 4 pancreatic and 4 hollow viscus). Two 
      patients died soon after arrival, 21 underwent laparotomy, 13 of which were liver 
      related, while 288 were treated non-operatively. One hundred and six patients 
      required blood transfusion (mean of 21.3 ml/kg); 30% of the nonoperative group 
      and 100% of the operative group. There were three fatalities from the operative 
      group (1% total mortality), one secondary to a severe, head injury, one liver 
      haemorrhage and one from multi-organ failure DISCUSSION: The vast majority (93%) 
      was successfully treated non-operatively with only 4% coming to liver related 
      laparotomy, complications were lower, transfusions less and the in-hospital 
      occupancy was shorter. Complication rate was 8% and mortality was 1%. CONCLUSION: 
      We confirm the success selective non-operative management of blunt liver trauma 
      as adopted by this institution 20 years ago. It is now proven treatment in an 
      appropriate centre. However, the challenge is to identify the severely injured 
      child early and institute aggressive resuscitation and expedite laparotomy when 
      indicated.
FAU - Landau, A
AU  - Landau A
AD  - Trauma Unit, Department of Pediatric Surgery, Red Cross Children's Hospital, 
      University of Cape Town, Cape Town, Rondebosch 7701, South Africa.
FAU - van As, A B
AU  - van As AB
FAU - Numanoglu, A
AU  - Numanoglu A
FAU - Millar, A J W
AU  - Millar AJ
FAU - Rode, H
AU  - Rode H
LA  - eng
PT  - Journal Article
DEP - 20051021
PL  - Netherlands
TA  - Injury
JT  - Injury
JID - 0226040
SB  - IM
MH  - Accidental Falls
MH  - Accidents, Traffic
MH  - Blood Transfusion
MH  - Child
MH  - Child Abuse
MH  - Child, Preschool
MH  - *Developing Countries
MH  - Female
MH  - Hemorrhage/diagnostic imaging/etiology
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Laparotomy
MH  - Length of Stay
MH  - Liver/diagnostic imaging/*injuries
MH  - Male
MH  - Multiple Trauma/diagnostic imaging/etiology/therapy
MH  - *Patient Selection
MH  - Retrospective Studies
MH  - South Africa
MH  - Tomography, X-Ray Computed
MH  - Violence
MH  - Wounds, Nonpenetrating/diagnostic imaging/etiology/*therapy
EDAT- 2005/10/26 09:00
MHDA- 2006/05/31 09:00
CRDT- 2005/10/26 09:00
PHST- 2005/01/31 00:00 [received]
PHST- 2005/07/08 00:00 [revised]
PHST- 2005/07/18 00:00 [accepted]
PHST- 2005/10/26 09:00 [pubmed]
PHST- 2006/05/31 09:00 [medline]
PHST- 2005/10/26 09:00 [entrez]
AID - S0020-1383(05)00274-3 [pii]
AID - 10.1016/j.injury.2005.07.013 [doi]
PST - ppublish
SO  - Injury. 2006 Jan;37(1):66-71. doi: 10.1016/j.injury.2005.07.013. Epub 2005 Oct 
      21.