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Operative vs Non-Operative Management of Pediatric Blunt Pancreatic Trauma: Evaluation of the National Trauma Data Bank
*Maria Carmen Mora1, *Kaitlyn E. Wong1, *Katharine R. Bittner1, *Jennifer Friderici1, Kevin P. Moriarty2, Ronald I. Gross1, Lisa A. Patterson1, Michael V. Tirabassi2, David B. Tashjian2
1Baystate Medical Center, Tufts University School of Medicine, Springfield, MA;2Baystate Children's Hospital, Tufts University School of Medicine, Springfield, MA
OBJECTIVE
To evaluate differences in outcomes among children with blunt pancreatic injuries managed operatively and non-operatively.
DESIGN
Database Review
SETTING
PATIENTS
The National Trauma Data Bank was evaluated from 2002-2011. Patients ≤18 y.o. with blunt pancreatic injuries and Abbreviated Injury Severity scores of ≥ 3 were identified. To reduce the likelihood of immortal time bias, deaths within 24h of admission were excluded. Patients were divided into non-operative (NO), operative (O), and delayed operative (DO) (operation performed ≥ 48h after admission) groups.
INTERVENTIONS
MAIN OUTCOME MEASURES
Main outcomes were LOS, and proportion of LOS in ICU. Covariates included age, sex, and injury severity scores (ISS). Univariate comparisons were performed using Fisher’s Exact and Kruskal-Wallis rank tests. Multivariable analyses were performed using robust regression (LOS) and fractional logit regression (proportion LOS in ICU).
RESULTS
424 cases were analyzed. The mean±SD age 10.6±5.3 years, ISS was 23.4±13.4. Most patients were male (63.9%) and white (79.1%). Operative groups differed by age (p=0.002), but were similar with regard to sex, race, and ISS.LOS was significantly higher in the DO group than NO or O groups (age-adjusted estimates: 18.9d vs. 11.9d, p<0.001 and 12.6d, p<0.001, respectively). Proportion of time in ICU was greatest in the DO group (vs. NO, p=0.03; O, p=0.29) as was the likelihood of any ICU (vs. NO, p=0.02; O, p=0.75). Death was similar between groups (p=0.80).
CONCLUSION
Overall, non-operative management has equivocal or better outcomes when compared to operative and delayed operative management in regards to LOS, ICU LOC, and ICU utilization. | Overall
n=424 | Operative
n=202 | Non-Operative
n=194 | Delayed
N=28 | | | median/IQR or n(%) | median/IQR or n(%) | median/IQR or n(%) | median/IQR or n(%) | P-Value | | Discharge Disposition | | | | | | | Home | 346 (81.6%) | 179 (88.6%) | 146 (75.3%) | 21 (75.0%) | | | Other Facility | 9 (2.1%) | 1 (0.5%) | 8 (4.1%) | 0 (0.0%) | | | Death | 13 (3.1%) | 5 (2.5%) | 7 (3.6%) | 1 (3.6%) | | | Other/Unknown | 56 (13.2%) | 17 (8.4%) | 33 (17.1%) | 6 (21.4%) | 0.007 | | LOS (days) | 12/7, 20 | 11/8,18 | 12/5,21 | 17/14, 26 | 0.002 | | Proportion LOS in ICU** | 0.17/0.0 0.13 | 0.24/0.07, 0.43 | 0.09/0.0, 0.35 | 0.35/0.07,0.56 | <0.001 | | % Requiring ICU** | 273 (69.5%) | 154 (79.0%) | 97 (56.7%) | 22 (81.5%) | <0.001 | Table 1: Unadjusted Outcomes, by Operative Group
*Fisher’s Exact (proportions), Kruskal-Wallis (medians) **n=393 |
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