blunt abdominal trauma guidelines

Article 3: Vaughn N, Tweed J, Greenwell D, Notrica DM, Langlais CS, St Peter SD, Leys CM, Ostlie DJ, Maxson RT, Ponsky T, Tuggle DW, Eubanks JW, Bhatia A, Greenwell C, Garcia NM, Lawson KA, Motghare P, Letton RW, Alder AC. We hope we don't have to do that very often, but it is a good reminder that not every patient can be managed nonoperatively. Multiplicity of injury is associated with increased mortality in blunt abdominal trauma, with rates increasing from 11% if only isolated liver or spleen injury occurs to 22% if both organs are damaged. Blunt Splenic Trauma. Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department [ 1 ], and is responsible for substantial morbidity and mortality. endstream endobj 667 0 obj <>/Metadata 25 0 R/Pages 664 0 R/StructTreeRoot 59 0 R/Type/Catalog>> endobj 668 0 obj <>/MediaBox[0 0 612 792]/Parent 664 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 669 0 obj <>stream Place order for MTG • Use the appropriate mechanism for ordering based on patient location. Failure of NOM was defined as needing laparoscopy or laparotomy.? East.org 2. 20 Because the bladder is well protected within the pelvis, the vast majority of injuries are associated with pelvic fractures. Though obesity was associated with a higher grade liver laceration, it was not associated with failure in non-operative management. It also has a thorough set of home instructions for families after hospital discharge. Blunt abdominal trauma and a diaphragmatic injury. 4 Indications for emergency laparotomy – blunt trauma A shortened period of bed rest of 1 day or less for stable children with unchanged hemoglobin levels. Updated APSA Blunt Liver/Spleen Injury Guidelines â¢APSA, Trauma Committee - Regan Williams - Harsh Grewal - Ramin Jamshidi - Bindi Naik-Mathuria - David Notrica - John Petty - Mitch Price - Rob Russell - Adam Vogel - Steve Stylianos . 2. Tenderness 3. Intervention rates were lower at freestanding children's hospitals than at non-freestanding children's hospitals (2.8% vs. 5.4%). Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. 8. Blunt trauma Patients who do not present with any predictive factors indicating intra-abdominal injury requiring urgent laparotomy or CT evaluation and have no other presenting problems may be observed with serial abdominal examinations and discharged if no reason for admission is found. Rostas J, Cason B, Simmons J, et al. that might identify which children with blunt torso trauma do not require abdominal CT scans? 2002 Sep;53(3):602-15. doi: 10.1097/00005373-200209000-00038. Blunt Trauma Blunt abdominal trauma commonly results from either a compression force or a deceleration injury. Overall mortality rate was 24% (8/34) in those who failed NOM due to bleeding. Physical examinations signs following blunt abdominal trauma should raise suspicion of a severe injury when the following are present: seatbelt injury, rebound tenderness, hypotension BP<90, abdominal distension, abdominal guarding and concomitant femur fracture. Call Blood Bank to notify them of MTG order via phone (3-6445) 4. The bladder rupture can occur into the peritoneal cavity (intraperitoneal bladder rupture) or outside the peritoneal cavity (extraperitoneal rupture). In the blunt abdominal trauma patient in whom intra-abdominal injury is suspected, FAST exam cannot reliably rule out injury and more definitive imaging by CT scan with contrast is recommended. INTRODUCTION â¢ Abdominal trauma is an injury to the abdomen. Blunt Abdominal Trauma 57-58 Blunt Splenic Trauma 59-60 Blunt Bowel and Mesenteric Injury 61-62 Rectal Injury 63-64 Pelvic Fracture 65-66 Peripheral Vascular Injury 67-68 Compartment Syndrome - Extremity 69-70 Compartment Syndrome - Fasciotomy 71 Trauma In Pregnancy 72-73 OB Trauma Response 74 TABLE OF CONTENTS. Link to article: Failure of NOM of BLS injuries. However, patients should be hemodynamically stable, as well as cooperative or sedated. Blast is a potent cause of blunt trauma in military practice, especially affecting gas-filled viscera [4,9]. â¦ A transfusion threshold of 7.0 g/dl is reasonable for children undergoing non-operative management. Blunt abdominal trauma 1. Does your institution treat children according to the anatomic grade? Example #2 is the flow chart from the key guideline reviewed above. Expert â¦ 1981 Apr; 21 (4):319–322. The solid organ care pathways submitted on the website represent a lot of hard work from some of our member institutions. What are the management guidelines for a patient with blunt abdominal trauma? Several adverse outcomes can occur in pregnancy, including placental abruption, preterm labor and preterm delivery, uterine rupture, and pelvic fracture. CT of the abdomen and pelvis in blunt trauma does not require the use of oral contrast. A literature search of Ovid, Clinical Key, and PubMed was completed using the terms pediatric blunt abdominal trauma, blunt abdominal trauma, pediatric trauma, and abdominal trauma and specific organs injured. Violation of the peritoneum occurs in between 20% and 80% of patients with penetrating trauma, depending on the type of weapon used.1,2 Conversely, â¦ Abdominal Trauma Hollow Viscus Injury Jamie J. Coleman, MDa, Ben L. Zarzaur, MD, MPHb,* INTRODUCTION Injuries to the stomach, duodenum, small intestine, and colon are common in pene-trating trauma and relatively rare in blunt trauma. JOINT TRAUMA SYSTEM CLINICAL PRACTICE GUIDELINE (JTS CPG) Blunt Abdominal Trauma, Splenectomy, and Post-Splenectomy Vaccination (CPG ID:09) To provide guidance on the management of combat casualties who sustain blunt abdominal trauma. This study attempts to determine the frequency and clinical characteristics of failure of NOM in pediatric BLSI patients. positive seatbelt sign), abnormal GCS or adjacent injuries (i.e. The close proximity of organs within the torso makes distinguishing between abdomen, chest and pelvic injuries difficult. J Pediatr Surg. h��W�n�8�>�(�D�� ĭ�&��Ԙ��%CRv��JT�ԭ��V��P�D��&BKx�#�l�L �p��Ix��@��!! Example #1 provides some nice background for care of these injuries. The assessment and treatment of children with specific injuries to the spleen, liver, pancreas, gastrointestinal tract or genitourinary tract are discussed separately. endstream endobj startxref This recent guideline was developed by the ATOMAC pediatric trauma consortium to update the practice management guidelines for treating blunt liver and spleen injuries (BLSI). It has greater mortality than penetrating as … Link to article: PECARN_Solid_Organ_Injury. �x��4��^ ��m�H�O�t8V�� с�� bQ�ጺ�V�8%��s��a��x��SCt��U�?�"D�0��_n`��{��An�M,��@��AYd� %��5�e`�` ��+# A total of 69 (7%) underwent laparotomy or laparoscopy, but only 34 (3%) underwent surgery for spleen or liver bleeding. [] Bass A 23 Strongly supported recommendation include: Finally, this guideline provides a treatment algorithm supported by the consortium's exhaustive review of the blunt trauma literature and thorough analysis using the GRADE methodology. Wilkinson AE. J Trauma Acute Care Surg. Three recent publications contribute to our understanding of pediatric solid organ injuries. Intra-abdominal injury following blunt trauma becomes 4. Contrast-enhanced computer tomography (CT) is the gold standard for the evaluation of blunt abdominal trauma [2, 5]. Yikes! Abdominal CT reports should include: organ injuries (or absence of), free uid, air or contrast and fractures identified. Blunt abdominal trauma during pregnancy poses a significant risk to both the mother and fetus. A total of 1008 patients met inclusion criteria. These evidence-based guidelines were developed after a thorough review of the literature regarding the evaluation and management of bladder injuries resulting from blunt abdominoperineal trauma. Blunt abdominal trauma can also result in rupture of intra-abdominal, retroperitoneal and pelvic hollow viscera. Trauma is a physical injury caused by transfer of energy to and within the person involved. It was theorized hepatic steatosis in the obese patients may make the liver more vulnerable to injury. 684 0 obj <>/Filter/FlateDecode/ID[<5AEC735B271D9441BFE30AEF97984584><0B783D96CEA648418838F5E09498A013>]/Index[666 43]/Info 665 0 R/Length 97/Prev 286025/Root 667 0 R/Size 709/Type/XRef/W[1 3 1]>>stream 8/28/17njm Blunt Abdominal Trauma in Pregnancy Background Anatomy First trimester -Uterus is an intrapelvic organ -Uterus is thick walled - providing muscular protection Second trimester: … Unstable patients should be considered for surgery, urgent embolization, or continued non-operative management, depending on other injuries and the center's resources. 2014;76:1020-1023. Methods: A literature review conducted through MEDLINE identified publications after the American Pediatric Surgery Association guidelines using the search terms blunt liver trauma pediatric, blunt spleen trauma pediatric, and blunt abdominal trauma pediatric. The âpanscanâ (computed tomographic [CT] examination of the head, neck, chest, abdomen, and pelvis) has become an essential element in the early evaluation and decision-making algorithm for hemodynamically stable patients who sustained abdominal trauma. (2015). Organ Injury Scaling Spleen Grade Injury Description AIS 90 I Subcapsular Haematoma, <10% surface area %%EOF Keep an eye on the PTS website for new ideas and ways to make the care of injured kids better. Answer: Question 4 (Kirkpatrick, 2013) Question 5. The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. Mechanisms of Injury and Pathophysiology of Abdominal Injuries in Blunt Trauma The most common causes of blunt abdominal trauma are motor vehicle collisions, falls from height, assaults, and sports accidents (). Blunt trauma produces a spectrum of injury from minor, single-system injury to devastating, multisystem trauma. 53(3): 602-615, September 2002. UEC: and glucose should be routinely taken. This guideline is intended for nonpregnant adult patients presenting to the emergency department with acute, blunt abdominal trauma. Example #4 provides some direction on caring for a child after splenectomy. Failure of nonoperative management of pediatric blunt liver and spleen injuries. Compression forces are those that result in abdominal organs and blood vessels being crushed between solid objects. They each use physiologic instability as a trigger for intervention. PTS would love to hear from you. Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group J Trauma . What Next? The articles were limited to humans, clinical trials, randomized controlled trials, practice guidelines, meta-analyses, and reviews. ]��m�E��i��a\��Ã�+�J��?��>�_]�]�M�x�]��.��۝%�~��&˷$�2}h�>]�v�'Th��m�Wev��~n��$��i@��-�[@��µ� }�H��(:��t��F;�j"�R_b�m��^ћ��{�G��O��;Z܌��~A$�QZYd�2_��d�$��"+�zv��^*OtuY��k�)mM�ԩe��K�_��q�#. Patients who failed NOM were more likely to receive blood. The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) consists of a group of Level I pediatric trauma centers from across the United States dedicated to performing clinical and preclinical studies aimed at optimizing management and functional outcomes for injured children. Toward this goal the workgroup has categorized the type of guideline, the sponsoring organization, how it was developed, and whether it has been tested or validated. Guidelines in Focus: Blunt Liver and Spleen Injury Blunt abdominal trauma Blunt trauma results in compression and shearing force injuries. The Cochrane Database of Systematic Reviews and the National Guidelines Clearinghouse were reviewed, but limited information on pediatric abdominal trauma was found. The available evidence is of very low quality, indicating that we are uncertain of the findings of the underlying report; future research is likely to change the reported estimates of effect. TABLE OF CONTENTS SICU GUIDELINE PAGE Surgical â¦ Blunt trauma produces a spectrum of injury from minor, single-system injury to devastating, multisystem trauma. Management of BLSI was based on the ATOMAC pediatric guideline. For children failing NOM due to bleeding, the mortality was 24%. Link to care pathways: Solid organ injury care pathways on PTS site. Associate Trauma Medical Director The previous practice management guideline gave rise to 27 clinical questions on blunt liver and spleen injury management. The Journal of Trauma and Acute Care Surgery, 79(4), 683�693. Trauma surgeons must have the ability to detect the presence of intra-abdominal injuries across this entire spectrum. Blunt abdominal trauma (BAT) represents 75% of all blunt trauma and is the most common example of this injury. This recent guideline was developed by the ATOMAC pediatric trauma consortium to update the practice management guidelines for treating blunt liver and spleen injuries (BLSI). Of note, surgeons should interpret CT findings cautiously before opting for OM because more than 50% of children present with grade IIIâIV lesions Blunt abdominal trauma (BAT) is an increasingly common problem encountered in the emergency department. Blunt abdominal trauma + hypotension with positive FAST scan, positive diagnostic peritoneal lavage (DPL) or peritonism; Interventional radiology. • EPIC MTG order set (ED or ICU patients) • Downtime paper form (OR patients) 3. Clinical studies looking at BCI in chest and abdominal trauma report incidences significantly lower than in autopsy series. 1981 Dec; 19 (4):245–249. Download Notrica, D. M., Eubanks, J. W., Tuggle, D. W., Maxson, R. T., Letton, R. W., Garcia, N. M., et al. The Ministry of Health and Family Welfare has issued the standard treatment General Surgery Guidelines for Blunt Abdominal Trauma. guideline from the Eastern Association for the Surgery of Trauma states “abdomino-pelvicCTshouldbestronglyconsideredasadiagnostictool”inhemodynamicallysta-ble patients with penetrating abdominal trauma.37 Despite its Answer: The pressure within the abdominal cavity, or intra-abdominal pressure in a normal person is 0-5 mmHg. 0 The results of this analysis guides our current and future research and potentially will provide a platform of evidence for other centers to consider. Stable patient with blunt trauma. Abdominal trauma is best categorised by mechanism as blunt or penetrating abdominal injury. Relevant earlier publications were identified and evidence reviewed using the GRADE system. These findings suggest that management of solid organ injuries varies widely across centers, and the presence of a widely endorsed guideline does not necessarily result in standardization of practice. Blunt abdominal trauma is more likely to be delayed or altogether â¦ Jones EL, Stovall RT, Jones TS, et al. Patients with a major trauma mechanism who are stable and present with only minor injury should undergo whole body CT (WBCT-S). Some of the same principles of nonoperative management could be applied to kidney and pancreas injuries, too. The mechanism of injury dictates the diagnostic work-up. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. All patients were managed based upon the ATOMAC protocol. Hypovolemia 5. Zaboli R(1), Tofighi S(1), Aghighi A(2), Shokouh SJ(3), Naraghi N(4), Goodarzi H(5). Byron D. Hughes MD MPH, Nathaniel Kreykes MD, Shannon Longshore MD, and John Petty, MD. Link to article: Impact of morbid obesity on solid organ injury. Combination of both? ��9�#�� C �H�$ .) Dell Children's Medical Center of Central Texas Angiography is a valuable modality in nonoperative management of abdominal solid organ injuries from blunt trauma in adults. The authors conclude that NOM fails in 7% of children with BLSI, but only 3% of patients failed for bleeding due to liver or spleen injury. The morbidity, mortality, and economic costs resulting from trauma in general, and blunt abdominal trauma in particular, are substantial. Abdominal trauma is best categorised by mechanism as blunt or penetrating abdominal injury. Other operations were for 21 intestinal injuries; 15 hematoma evacuations, washouts, or drain placements; 9 pancreatic injuries; 5 mesenteric injuries; 3 diaphragm injuries; and 2 bladder injuries. This review subjects the guideline to analysis based on Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology to rate the level of evidence associated with the practice management guideline. Clinical Radiology 2013 ; Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE ; Laparoscopy in Pediatric Abdominal Trauma: A 13-Year Experience