The efficacy of non-operative management in childhood blunt hepatic trauma

BACKGROUND: In this study the results of non-operative management of pediatric hepatic injury after blunt abdominal trauma were evaluated. METHODS: Multitrauma patients (n = 498) admitted between 1998 and 2002 were analysed as for mechanism of trauma retrospectively. Liver injuries were classified according to the American Association for the Surgery of Trauma’s Organ Injury Scaling System. Liver function tests, transfusion status, duration of hospital stay, complications, and operative intervention needed were recorded. RESULTS: Seventy-five patients had liver injuries. The mean age was 6.7 years and male/female was 2.5/1. Number of patients in terrms of injury grade: I: 15, II: 26, III: 29, IV: 4, V: 1. There was no significant difference between mean blood pressures, heart rates, and hematocrite values on admission and post-stabilisation. In three of 21 transfused patients, it exceeded 40 ml/kg and two of them were operated. The mean pediatric trauma score was +2. As a complication biloma was encountered in one patient. One patient with grade V hepatic injury died in the operating room because of heavy bleeding. The average hospital stay was 8,6 days. CONCLUSION: Our results support the efficacy of non-operative management of any grade hepatic injuries due to blunt abdominal trauma, with resultant low complication and mortality rates and shorter hospital stays.