Solid Organ trauma an
Offally good approach
Juliette King
Department 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
Boating
Motor Vehicle-inside
Motor Vehicle-outside
Sport
Fall from height
Fall
NAI
Handlebar
Tests
 Elevated transaminases
 Decreased haemaglobin
 Micro or macroscopic haematuria
 Elevated amylase
Ethnicity
Maori
European
Pacific Island
Indian
Chinese
Other
Signs and symptoms
 Handlebar marks
 Bruises over flanks
 Unconscious patient
 Abdominal tenderness
 Seat belt marks
 Chest or pelvic injury
Organ Injured
liver
spleen
Kidney
Pancreas
Multiple
AAST Grading Liver
http://www.aast.org/library/traumatools/injuryscoringscales.aspx
Grade of Injury
25
20
15
Liver
Spleen
Kidney
10
5
0
1
2
3
4
5
Length of stay
16
14
12
10
Liver
Spleen
8
Kidney
6
APSA
4
2
0
1
2
3
4
5
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