52 - Epidemiology and Management of Abdominal Injuries in Children

Poster Number: 52
Publication Number: 52.104

Pradip P. Chaudhari, Children's Hospital Los Angeles, Los Angeles, CA, United States; Jonathan Rodean, Children's Hospital Association, Lenexa, KS, United States; Ryan G. Spurrier, Children’s Hospital Los Angeles, Los Ángeles, CA, United States; Matthew Hall, Children's Hospital Association, Lenexa, Kansas, KS, United States; Jennifer Marin, UPMC Childrens Hospital of Pittsburgh, PIttsburgh, PA, United States; Sriram Ramgopal, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Elizabeth R. Alpern, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Samir S. Shah, Journal of Hospital Medicine, Cincinnati, OH, United States; Stephen Freedman, University of Calgary, Calgary, AB, Canada; Eyal Cohen, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Rustin Morse, Nationwide Children's Hospital, Columbus, OH, United States; Mark I. Neuman, Boston Children's Hospital, Boston, MA, United States

Background: Although more guideline-adherent care has been described in pediatric compared to adult trauma centers, a detailed characterization of management and resource utilization of children with intra-abdominal injury (IAI) within pediatric centers has been more limited.

Objective: Our primary objective was to describe the epidemiology, evaluation, and management of children with IAI across U.S. children’s hospitals. Our secondary objectives were to describe inter-hospital variation and temporal trends in the surgical management of children with IAI.

Design/Methods: We conducted a cross-sectional study of 33 hospitals in the Pediatric Health Information System. We included children aged < 18 years evaluated in the ED from 2010-2019 with IAI defined by ICD coding and who underwent an abdominal CT. Our primary outcome was the proportion of eligible children whose management included abdominal surgery. We categorized IAI by organ system and described resource utilization data. We examined inter-hospital variation using generalized linear regression to calculate adjusted hospital-level proportions undergoing abdominal surgery, with a random effect for hospital. To describe trends in the surgical management of IAI, liver and splenic injuries during the study period, we added a linear term for year in the model.

Results: We identified 9,265 eligible children. Median (IQR) age was 9.0 years (IQR: 6.0, 13.0). Abdominal surgery was performed in 16% (n=1,479) of children (Table 1), with the lowest proportion of abdominal surgery observed in children aged < 5 years. Liver (38.6%) and spleen (32.1%) were the most common organs injured. Among children with single abdominal organ injuries, 3.1% of children with liver and 2.8% with splenic injuries underwent abdominal surgery (Table 2). Although there was variation in rates of surgery across hospitals (p < 0.001), only 3/33 hospitals had rates that differed from the aggregate mean of 16% (Figure). While the adjusted proportion of children with liver injuries with abdominal surgery performed increased (p=0.001), the proportion of children with splenic injuries with surgery remained stable (p=0.16).Conclusion(s): Most children with IAI are managed non-operatively, and although some institutional variation was identified, most children's hospitals managed children similarly. Abdominal surgery for liver and splenic injuries remained < 5% over the last decade, however surgical management for liver injuries increased, whereas for splenic injuries it remained stable. These data can inform future benchmarking efforts to assess concordance with pediatric IAI management guidelines.
Table 1. Management, resource utilization, and outcomes of children with IAIFootnotes:
Proportions might not sum to 100% due to rounding
Abbreviations: ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; CT, Computed tomography; ED, Emergency Department; IAI, intra-abdominal injury; ICU, intensive care unit; INR, International normalized ratio; LOS, Length of stay; PT, Prothrombin time; PTT, Partial thromboplastin time
*Comparisons made using the chi squared test
Table 2. IAI type and severity in subgroup of children with single abdominal organ injury, stratified by abdominal surgery