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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  - To review the number of citations for this landmark paper, visit Google Scholar.

Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely.
Streck CJ, Vogel AM, Zhang J, Huang EY, Santore MT, Tsao K, Falcone RA, Dassinger MS, Russell RT, Blakely ML; Pediatric Surgery Research Collaborative.
J Am Coll Surg. 2017 Apr;224(4):449-458.e3.

Rationale for inclusion: Large, multi-institutional prospective study which included data from 14 PTC to develop a 5 variable clinical predication rule combining history, physical exam, chest x-ray and screening labs to identify children at very low risk for any intra-abdoominal injury in whom Abdominal CT is likely unnecessary

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE.
Notrica DM, Eubanks JW, Tuggle DW, Maxson RT, Letton RW, Garcia NM, Alder AC, Lawson KA, St Peter SD, Megison S, Garcia-Filion P.
J Trauma Acute Care Surg. 2015 Oct;79(4):683-93.

Rationale for inclusion: Updated management guidelines for management of liver and spleen injury in children based on GRADE methodology to assess the evidence supporting the guidelines.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Identifying children at very low risk of clinically important blunt abdominal injuries.
Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey BT, Mahajan P, Adelgais K, Ellison AM, Yen K, Atabaki S, Menaker J, Bonsu B, Quayle KS, Garcia M, Rogers A, Blumberg S, Lee L, Tunik M, Kooistra J, Kwok M, Cook LJ, Dean JM, Sokolove PE, Wisner DH, Ehrlich P, Cooper A, Dayan PS, Wootton-Gorges S, Kuppermann N; Pediatric Emergency Care Applied Research Network (PECARN)
Send to Ann Emerg Med. 2013 Aug;62(2):107-116.e2.

Rationale for inclusion: Large, prospective multi-institutional study which included data from 20 pediatric trauma centers which developed a clinical prediction rule using history and physical exam findings  to identify children at very low risk of abdominal injuries requiring intervention in whom abdominal CT could be potentially avoided

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Computed tomography--an increasing source of radiation exposure.
Brenner DJ, Hall EJ.
N Engl J Med. 2007 Nov 29;357(22):2277-84.

Rationale for inclusion: Summary article which highlights the rapid expansion of abdominal CT and the biologic effects of low doses of ionizing radiation, primarily cancer risks, particularly in children. This study highlights the need for wide dissemination of pediatric trauma management guidelines

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers: a call for dissemination of American Pediatric Surgical Association benchmarks and guidelines.
Stylianos S, Egorova N, Guice KS, Arons RR, Oldham KT.
J Am Coll Surg. 2006 Feb;202(2):247-51. Epub 2005 Dec 19.

Rationale for inclusion: Study comparing outcomes for children with blunt spleen injuries at TC and non-TC showing siginificantly lower rates of operative intervention at trauma centers

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Identification of children with intra-abdominal injuries after blunt trauma.
Holmes JF, Sokolove PE, Brant WE, Palchak MJ, Vance CW, Owings JT, Kuppermann N.
Ann Emerg Med. 2002 May;39(5):500-9.

Rationale for inclusion: Landmark study designed to determine the utility of routine lab testing in determining children with intra-abdominal injuries following blunt abdominal trauma

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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

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

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 show be based on patient physiology rather than imaging.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 differs from adult spleen injuris, and how the approach to these injuries could be different in children than in adults.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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