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.

Selective Computed Tomography (CT) Versus Routine Thoracoabdominal CT for High-energy Blunt-trauma Patients

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt trauma patients. This review was selected for the TREKK Evidence Repository on multiple trauma.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Regular or selected use of CT scanning to reduce deaths in people who have a high-energy blunt-traumatic injury

Background

Trauma is the fifth leading cause of death in the world, and in people younger than 40 years of age, it is the leading cause of death. Since the 2000s, CT has been increasingly used in the trauma bay. It is more sensitive and specific than conventional radiography and ultrasonography. By the 2010s, with technical and infrastructural improvements, CT has evolved into a reliable and important method of diagnostic imaging in trauma.

Blunt injury may occur following a direct impact (e.g. forced against a steering wheel or floor) or an indirect impact (e.g. acceleration-deceleration). It is difficult to identify which part of the body is injured following blunt injury and quick and accurate diagnoses are essential to reduce disability and death. The Advanced Trauma Life Support (ATLS®) system is the most commonly used approach and involves a clinical examination and use of diagnostic methods that recognise the most life-threatening injuries that should be treated first. In the ATLS® approach, conventional diagnostic imaging is performed first (e.g. X-rays and focused abdominal sonography), followed by selective use of CT of specific body regions if required. In contrast, the use of routine thoracoabdominal (chest and abdomen) CT ensures that therapeutic decisions can be made based on detailed anatomical information of the injuries rather than clinical suspicion. This may lead to quicker and more accurate assessment of injuries present. Consequently, this may lead to improved outcomes.

Study characteristics

We searched medical databases for publications of randomised controlled trials (RCTs) (a clinical study where participants are randomly allocated into treatment groups) comparing the usual approach versus selected use of CT scanning. We included studies of all types of blunt trauma and excluded studies with people with penetrating injuries (e.g. gunshot or knife wounds) and pregnant women. The searches are up-to-date to May 2013.

Key results

We found no published or ongoing randomised controlled trials that compared routine versus selective thoracoabdominal CT in blunt-trauma patients. At this time, it is not possible to say which approach is better for patients, or reduces death.

Authors’ Conclusions:

We found no RCTs of routine versus selective thoracoabdominal CT in patients with blunt high-energy trauma. Based on the lack of evidence from RCTs, it is not possible to say which approach is better in reducing deaths.

Check Out the Full Cochrane Systematic Review Below:

Van Vugt, R., Keus, F., Kool, D., Deunk, J., Edwards, M. (2013). Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients. Cochrane Database Syst Rev, 12, CD009743. doi: 10.1002/14651858.CD009743.pub2

Take Home Message:

There is a great need for high-quality research to identify the most efficient, effective approach to identifying areas of injury in high-energy blunt-trauma patients. Check out the resources developed by TREKK for more on what is currently known. Also follow us on Twitter @Cochrane_Child and @TREKKca for more 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.