Solid organ injury in Blunt abdominal trauma in pediatrics: Ain Shams university hospitals practice and review of literature

Abstract

Children are not just little adults; they are different in their anatomical structure and in their physiological compensation. These differences make them react differently when exposed to traumatic incidents. Pediatric surgeons should be fully trained to manage cases of pediatric trauma; they should be able to thoroughly examine trauma patients in the ER, going through primary, secondary and tertiary surveys in order not to miss an injury and to formulate a proper managing plan. Solid organ injuries caused by blunt abdominal trauma are treated conservatively in most of cases as long as vital stability could be maintained. The main purpose of its management is to decrease the mortality rate, unnecessary investigations, hospital stay and to minimize the physical and emotional impact of trauma on children. CT scans are crucial in the diagnosis and grading of solid organ abdominal trauma. Unfortunately, double contrast CT is not always available in our casualties and it is mostly done on the next day of admission. This causes at least a one day delay to properly diagnose the patient and put a plan for his/her stay in our hospital. Because of this delay, there is a tendency to admit patients directly in the ICU before the results of the CT which leads to unnecessary and non-indicated occupancy of ICU beds. This causes a waste in precious ICU beds and in the efforts of the ICU nursing team. Unnecessary follow up investigations were also routinely withdrawn in the ICU that had no significance in the length of admission or the management plan. In the last 6 months records, most of the admitted liver and/or spleen injury patients stayed for longer days than they should as regard their grades of injuries. Some patients had follow up ultrasonography while admitted or advised for post-discharge follow up, all of which has no impact on patient hospitalization length or any significance in patients follow up. Limited resources is an obstacle that stands in the face of giving our patients the quality of health care they deserve, but while overcoming this obstacle we should have the knowledge to save, not only patients’ lives, but also the human and financial resources that will play a role in improving the quality of service that our children should receive.