html?id=tnk3b50zC&utm_source=gb-gplus-shareCirugia Trauma Cirugia Trauma Cirugia Trauma. edited by Carlos Hernando Morales Uribe. Title, Cirugia: Trauma Yuluka: Medicina. Contributor, Carlos Hernando Morales Uribe. Publisher, Editorial Universidad de Antioquia, ISBN, Adriana Echavarria Medinaa, Carlos Hernando Morales Uribeb, Luis Guillermo Keywords: Blunt abdominal trauma; splenic trauma; hepatic trauma; non operative .. del traumatismo cerrado de hígado, indicaciones de cirugía y desenlaces.
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Associated factors to non-operative management failure of hepatic and splenic lesions secondary to blunt abdominal trauma in children. The non operative management NOM is the standard management of splenic and liver blunt trauma in pediatric patients.
Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma. Of 67 patients who received NOM, 58 were successful and 9 showed failure 8 hemodynamic instability, 1 hollow viscera injury. We found 3 factors associated with failure NOM: Children with blunted hepatic or splenic trauma respond to NOM.
Blunt abdominal trauma; splenic trauma; hepatic trauma; non operative; management. Trauma is the main cause of morbidity and permanent disability in children between 1 and 14 years old In Colombia, a Although the principles of trauma in pediatrics are similar to those of the adult population, there are anatomical and physiological characteristics in the pediatric group that make it more susceptible to injury to intra-abdominal organs such as: In most cases, these lesions can be managed without surgery 6, This therapeutic approach is called non-operative Management NOM and it is defined as that management performed in the patient, after a primary and secondary revision and after the taking the relevant images, which support the decision of not perfoming surgery immediately 12, Design and ethical aspects of the study.
For data collection, a format was used that assessed: The included patient should present hemodynamic stability, absence of signs of peritoneal irritation 1,4,9,10,12,13,18,19,23,28,29whose age were between years old, with an initial NOM for hepatic or splenic trauma, no trauma to other solid organs or other voids rather than liver or spleen, which has required to proceed with surgery; patients who present evidence of tomographic images for classification of hepatic or splenic trauma and evidence of clinical and paraclinical data Hb levels in clinical history.
Patient who died at admission, or who needed surgery on admission, or with clinical or paraclinical incomplete information, incomplete imaging or that does not allow an analysis of the proposed variables figure 1: Flowchart number of patients recruited into the study. Flowchart of patients included in the study. For some variables of interest, we also calculate the difference of proportions with their respective p value.
From the 70 patients initially included, 46 were male The most common cause of trauma was the pedestrian accident Some of the patients had more than one associated lesion.
These data are described in table 1. From the 70 patients, 3 were derived to immediate surgery: These patients were excluded from the study. Thus, from the remaining 67 patients In all of these, the extravasation of the contrast medium in the initial CAT was observed.
Handling of patients with blunt abdominal trauma in children. From the 67 patients who received NOM, 9 patients had a failure to manage Table 3 establishes a comparison of Clinical and Paraclinical information among patients, in whom the NOM was successful and those who presented failure in it. The variables with a statistically significant relationship with NOM failure were: On the contrary, no statistically significant relationship was found between NOM failure and trauma mechanism, severity of lesions, and hemoperitoneum of more than 2 quadrants.
Finally, we found that intrahospital complications occurred in 8 of our patients, 4 The complications presented are listed in Table 4. The hospital stay was In most of these patients, the prolonged stay was secondary to other associated injuries, such as traumatic brain injury, complex pelvic fracture, unilateral or bilateral hemoneumotorax, renal trauma, diaphragmatic hernia and costal fractures.
The hospital stay average for the NOM failure group was In Colombia, pediatric trauma is responsible uirbe Similar to what was previously reported in other series 1,3,6,7,15,23,27pedestrian-like traffic accidents are the predominant trauma mechanism in the hepatic and splenic injuries due to closed trauma in our study group, followed by falls from high heights in second place and others less common causes, as trauma on bicycle or skateboards, trauma with blunt objects cirugua others.
The most affected group was the 5 to 10 years old children. In our analysis, we found that abdominal CAT was used very frequently for the initial approach. In this study, we performed an analisys in 64 out of the 67 patients who decided to perform NOM Although it is clear that CAT is still the diagnostic image of choice for the evaluation of these patients, there is a strong and growing informed people who seek to reduce the number of CAT scans performed in children, due to the risk of ionizing radiation Regarding what was mentioned above, we have tried to create diagnostic algorithms involving the FAST echo Focused Abdominal Sonography for Trauma which, when hernabdo a negative result, strongly suggests the absence of major intra-abdominal trauma with a high negative predictive value, defining the patient group who would benefit from a larger study, such as CAT 33, Conventional ultrasound has been used, together with the clinical moarles described above and serial clinical evaluation, as a safe method of diagnosis that allows surgical decision making and to select those patients who really need to be taken to tomographic studies.
In our study, it was evidenced that despite having these resources FAST echo in 4. In the last years, the NOM has been considered as moeales fundamental tool in the hepatic 17 and splenic lesions secondary to closed abdominal trauma management, supported by the use of CAT, along with a better knowledge of the pathophysiology of this type of injuries 1,4, NOM could fail The above is clear, a periodic evaluations by trained personnel are necessary in order to allow the early detection of the surgical interventions need and to identify patients at high risk, avoiding failure of NOM 6,7,23,27, Despite the above, laparotomy and angioembolization outcomes hednando rare 13,15,19, We found 3 urieb that presented a statistically significant relationship with failure in this management: Multiple studies are in agreement with what is found in our series of patients, although most of these are focused on determining ugibe points to move from NOM to surgical management and not to establish factors that act as predictors of this outcome or to prevent the complications associated with the delay of these 6,7,23, This may lead to better timing of surgical intervention and it may decrease the occurrence of complications associated with transfusion therapy, as well as increasing vascular permeability, such moralex pleural effusions, respiratory distress, rebleeding, transfusion reactions, carlo others 1.
Carlos Hernando Morales Uribe – Semantic Scholar
The pediatric trauma index variables: In our series, we found no relationship between NOM failure and the mechanism or severity of hepatic or splenic trauma, and the presence of hemoperitoneum in more than 2 quadrants, although other series have found such association 1,24,27,28we did not.
It is possible that these differences are due to hermando small number of patients from the different studies mentioned. The main complications reported are 1,4,7,11, In our series, the rate of complications was very low in 6. It should be determined if earlier surgical intervention in the group of patients with NOM failure based on criteria, such as those mentioned above, may yrauma the incidence of these complications or if it may improve morbidity and mortality.
The retrospective nature and mprales size were the main limitations in our study, which is consistent with the low precense of this type of trauma in the pediatric population. In conclusion, most of children with closed hepatic or splenic trauma respond adequately and without complications to NOM.
No relationship was found between the imaging findings, lesion degree and magnitude of hemoperitoneum mlrales NOM failure in our study.
Cirugia Trauma – Google Books
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