Non-operative Versus Operative Treatment for Blunt Pancreatic Trauma in Children

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on non-operative versus operative treatment for blunt pancreatic trauma in children. This review was selected for the TREKK Evidence Repository on multiple trauma.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Treatment of severe blunt pancreatic lesions in children

Background

Optimal treatment of severe blunt pancreatic trauma in children has long been debated, some doctors advocate operation while others prefer a conservative approach without operation as primary treatment. We conducted this systematic review to assess which strategy should be preferred. Blunt trauma to the pancreas typically occurs after crashes involving a bicycle handlebar, road traffic crashes or other types of injury that cause a blow to the upper abdomen.

Study characteristics

We searched medical databases for randomised (where two groups of children were randomly assigned to treatment or no treatment) clinical trials of children treated for blunt trauma to the pancreas by an operation or no operation. The children were aged 17 years or younger. The search was current to June 2013.

Key results

We found no randomised clinical trials investigating operative treatment compared with non-operative treatment of severe pancreatic injury in children, hence we have no firm evidence to support either operative treatment or non-operative treatment of severe pancreatic lesions in children. Although difficult because of the rarity and the acute nature of these lesions, we recommend that multicentre randomised clinical trials of good quality are conducted.

Authors’ Conclusions:

This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials. We recommend that multi-centre trials evaluating non-operative versus operative treatment of paediatric pancreatic trauma are conducted to establish firm evidence in this field of medicine.

Check Out the Full Cochrane Systematic Review Below:

Haugaard, M.V., Wettergren, A., Hillinsø, J.G., Gluud, C., Penninga, L. (2014). Non-operative versus operative treatment for blunt pancreatic trauma in children. Cochrane Database Syst Rev, 2, CD009746. doi: 10.1002/14651858.CD009746.pub2

Take Home Message:

As described by the Cochrane review authors, evidence from randomised trials is needed to develop recommendations for the treatment of blunt pancreatic injuries in children. Check out the resources developed by TREKK for more information on what is currently known. Also follow us on Twitter @Cochrane_Child and @TREKKca for more information on this topic throughout the week.

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This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.

Antibiotics for Preventing Infection in Open Limb Fractures

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on antibiotics for preventing infection in open limb fractures. This review was selected for the TREKK Evidence Repository on fractures.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Antibiotics for preventing infection in open limb fractures

Wound and bone infections are common complications following open fractures of the limbs. For more than 20 years in developed countries, the use of antibiotics has been a part of a standard management protocol that also includes washing the wound (irrigation), cleaning up the wound and fracture (surgical debridement), and stabilisation of the fracture, as required. This review, which included data from 1106 participants in eight trials, found that antibiotics are effective in decreasing the incidence of wound infections, as compared with no antibiotics or placebo. No studies reporting bone infection or long-term ill health (morbidity) were identified.

Authors’ Conclusions:

Antibiotics reduce the incidence of early infections in open fractures of the limbs. Further placebo controlled randomised trials are unlikely to be justified in middle and high income countries, except for open fractures of the fingers. Further research is necessary to the determine the avoidable burden of morbidity in countries where antibiotics are not used routinely in the management of open fractures.

Check Out the Full Cochrane Systematic Review Below:

Gosselin, R.A., Roberts, I., Gillespie, W.J. (2004). Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev, 1, CD003764. doi: 10.1002/14651858.CD003764.pub2

The Cochrane Bone, Joint and Muscle Trauma Group also recommends the following systematic reviews related to fractures in children:

Black, K.J., Bevan, C.A., Murphy, N.G., Howard, J.J. (2013). Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database Syst Rev, 12, CD009587. doi: 10.1002/14651858.CD009587.pub2

Yeung, D.E., Jia, X., Miller, C.A., Barker, S.L. (2016). Interventions for treating ankle fractures in children. Cochrane Database Syst Rev, 4, CD010836. doi: 10.1002/14651858.CD010836.pub2

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This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.