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Non-operative versus operative treatment for blunt pancreatic trauma in children

  1. Michael V Haugaard1,*,
  2. André Wettergren2,
  3. Jens Georg Hillingsø1,
  4. Christian Gluud3,
  5. Luit Penninga4

Editorial Group: Cochrane Injuries Group

Published Online: 12 FEB 2014

Assessed as up-to-date: 21 JUN 2013

DOI: 10.1002/14651858.CD009746.pub2


How to Cite

Haugaard MV, Wettergren A, Hillingsø JG, Gluud C, Penninga L. Non-operative versus operative treatment for blunt pancreatic trauma in children. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD009746. DOI: 10.1002/14651858.CD009746.pub2.

Author Information

  1. 1

    Rigshospitalet, Copenhagen University Hospital, Department of Surgery and Transplantation C2122, Copenhagen, Denmark

  2. 2

    Kirurgisk Klinik Hvidovre, Hvidovre, Denmark

  3. 3

    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, The Cochrane Hepato-Biliary Group, Copenhagen, Denmark

  4. 4

    Rigshospitalet, Copenhagen University Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Copenhagen, Denmark

*Michael V Haugaard, Department of Surgery and Transplantation C2122, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100 Ø, Denmark. michaelhaugaard@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 12 FEB 2014

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Table 1. Pancreatic organ injury scale of the American Association for the Surgery of Trauma

GradeInjuryDescription

IHaematomaMinor contusion without duct injury

 LacerationSuperficial laceration without duct injury

IIHaematomaMajor contusion without duct injury or tissue loss

 LacerationMajor laceration without duct injury or tissue loss

IIILacerationDistal transection or parenchymal injury with duct injury

IVLacerationProximal transection or parenchymal injury involving ampulla

VLacerationMassive disruption of pancreatic head

 
Table 2. Treatment of blunt pancreatic trauma in children, grade I to II

Primary authorYear, countryNumber of children (n), gradeTreatmentMortalityPancreas-related complicationsOther complicationsSuccess of NOM

Juric 20092009, Croatia7, grade I-IINOM0%43% (Grade ll, pseudocysts)43% (2 sepsis, 1 pleural effusion)100%

 NOM: non-operative management; OM: operative management.
'Success of NOM' was defined as primary NOM where no secondary surgery was needed.
 
Table 3. Treatment of blunt pancreatic trauma in children, grade III to V

Primary authorYear, countryNumber of children (n), gradeTreatmentMortalityPancreas-related complicationsOther complicationsSuccess of NOM

Canty 20012001, USA18, grade III-IV9 OM vs. 7 NOM, 2 deaths11% (severe head trauma)OM 0%

NOM 100%
-29%

Keller 19971997, USA154, grade I-VGrade I-II: 26 OM vs. 97 NOM

Grade III-V: 16 OM vs. 15 NOM
8%Grade I-II: 10%

Grade III-V: 32%
--

Wales 20012001, Canada9, grade III-V9 NOM0%44%33% (subphrenical abscess, sepsis occurred twice)100%

 '-' indicates that it was not possible to extract data from the given study.
NOM: non-operative management; OM: operative management; TPN: total parenteral nutrition.
'Success of NOM' was defined as primary NOM where no secondary surgery was needed.
 
Table 4. Treatment of blunt pancreatic trauma in children, grade I to V or not specified

Primary authorYear, countryNumber of children (n), gradeTreatmentMortalityPancreas-related complicationsOther complicationsSuccess of NOM

Wood 20102010, USA44, grade I-IV14 OM vs. 29 NOM, 1 death4% (multi-trauma)OM 21% vs. NOM 73%OM 57% vs. NOM 20%-

Fabbro 20012001, Italy92 OM vs. 7 NOM0%OM 50% vs. NOM 71%-86%

Bass 19911991, South Africa408 OM vs. 32 NOM0%NOM 38%OM 13% (respiratory stop, abscess)100%

Bass 19881988, Canada2611 OM vs. 15 NOM0%OM 18% vs. NOM 53%-93%

de Blaauw 20082008, The Netherlands34, grade I-IV3 OM vs. 31 NOM0%OM 66% vs. NOM 45%NOM 13% (sepsis)90%

Firstenberg 19991999, USA12, grade I-V7 OM vs. 5 NOM17% (multi-organ injury)42%--

Gorenstein 19871987, Canada218 OM vs. 13 NOM10% (aorta laceration, head trauma)OM 25% vs. NOM 77%-77%

Graham 20002000, Scotland161 OM vs. 15 NOM0%NOM 67%-80%

Holland 19991999, Australia1414 NOM0%NOM 57%-79%

Nadler 19991999, USA5127 OM vs. 24 NOM---79%

Kouchi 19991999, Japan201 OM vs. 19 NOM5% (acidosis after TPN)NOM 50%-84%

Mattix 20072007, USA173, grade I-V43 OM vs. 130 NOM---74%

Shilyansky 19981998, Canada28, grade I-V28 NOM0%36%4% (pelvic abscess)100%

Stringer 20052005, UK9, grade I-IV1 OM vs. 8 NOM0%OM 0% vs. NOM 100%OM 100% (sepsis)38%

Takishima 19961996, Japan81 OM vs. 7 NOM0%OM 100% vs. NOM 14.3% -100%

 '-' indicates that it was not possible to extract data from the given study.
NOM: non-operative management; OM: operative management; TPN: total parenteral nutrition.
'Success of NOM' was defined as primary NOM where no secondary surgery was needed.