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Blunt Abdominal Injury

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Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial.
Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, Tancredi DJ, Kuppermann N.
JAMA. 2017 Jun 13;317(22):2290-2296.

Rationale for inclusion: 925 children randomized to standard trauma evaluations with or without FAST examinations. No improvements in clinical care were reported for those who underwent FAST examination. 

CAVEAT: These were hemodynamically normal children

Citations - 1 (as of October 2017)

Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Committee.
Stylianos S.
J Pediatr Surg. 2000 Feb;35(2):164-7; discussion 167-9.

Rationale for inclusion: This was the first paper to by a national organization (APSA Trauma Committee) to set clear evidence based guidelines for the treatment of children with blunt solid organ injury.

Citations - 241 (as of July 2017)

Nonoperative management of blunt hepatic and splenic injury in children.
Bond SJ, Eichelberger MR, Gotschall CS, Sivit CJ, Randolph JG.
Ann Surg. 1996 Mar;223(3):286-9.

Rationale for inclusion: A foundation paper demonstrating that nonoperative treatment of solid organ injury can be very successful.  156 children treated non-operatively for blunt solid organ injury over 6 years. 97.4% success rate.

Citations - 181 (as of July 2017)

Hepatic and splenic injury in children: role of CT in the decision for laparotomy.
Brick SH, Taylor GA, Potter BM, Eichelberger MR.
Radiology. 1987 Dec;165(3):643-6.

Rationale for inclusion: One of the first attempts at development of an imaging based grading system for solid organ injuries in pediatrics. They showed that CT can help define the need of operative intervention but more importantly showed that an operation should be based on patient physiology rather than imaging.

Citations - 106 (as of July 2017)

Upper abdominal trauma in children: imaging evaluation.
Kaufman RA, Towbin R, Babcock DS, Gelfand MJ, Guice KS, Oldham KT, Noseworthy J.
AJR Am J Roentgenol. 1984 Mar;142(3):449-60.

Rationale for inclusion: One of the first studies to demonstrate the effectiveness (and superiority) of CT in trauma compared to scintigraphy and ultrasound.  100 patients over 20 months.  CT clearly provided the most information.

Citations - 141 (as of July 2017)

CT of blunt abdominal trauma in childhood.
Berger PE, Kuhn JP.
AJR Am J Roentgenol. 1981 Jan;136(1):105-10.

Rationale for inclusion: The original paper describing the validity of CT scanning for the assessment of children with abdominal trauma. They did elegant studies comparing CT, angiogram, and IVP.  

Citations - 119 (as of July 2017)

Nonoperative management of traumatized spleen in children: how and why.
Ein SH, Shandling B, Simpson JS, Stephens CA.
J Pediatr Surg. 1978 Apr;13(2):117-9.

Rationale for inclusion: This was one of the first papers to describe a systematic approach to the non-operative treatment of splenic injury.  The authors describe a large 35 year experience.  This work has been the foundation for modern non-operative treatment of blunt solid organ injury.

Citations - 204 (as of July 2017)

Splenic trauma in children.
Upadhyaya P, Simpson JS.
Surg Gynecol Obstet. 1968 Apr;126(4):781-90.

Rationale for inclusion: Another highly cited foundation paper describing normal patterns of splenic injury in children, how these differ from adult spleen injuries, and how the approach to these injuries could be different in children than in adults.

Citations - 230 (as of July 2017)

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