Management Strategies and Outcomes of Paediatric Blunt Abdominal Trauma at a Tertiary Care Centre in South Kerala: A Retrospective Observational Study

Abstract

Introduction: Blunt abdominal trauma is a leading cause of injury in paediatric population. The management of paediatric abdominal injury has shifted from Operative Management (OM) to Non Operative Management (NOM) over years. NOM is the standard treatment for clinically stable patients with blunt trauma abdomen. Aim: To describe retrospectively the management strategies and outcomes of paediatric patients with blunt abdominal trauma in a tertiary care centre. Materials and Methods: This was a retrospective observational record-based study that included 96 medical records of children admitted in Government Medical College, Thiruvananthapuram, Kerala, India, with blunt trauma abdomen from January 2018 to December 2022. Patients were characterised according to the treatment they received as- NOM and OM. Ultrasound Focused Assessment with Sonography in Trauma (USG FAST) and Contrast Enhanced Computed Tomography (CECT) abdomen were done in all the patients. The factors recorded were- age, gender, mechanism of injury, concomitant injury, tachycardia, hypotension, respiratory rate, blood transfusion requirement, injuries (American Association of Surgery of Trauma (AAST) organ injury scale), length of Intensive Care Unit (ICU) and hospital stay and mortality. Univariate analysis of the clinical features were done using Chi-square test using Statistical Package for the Social Sciences (SPSS) 27.0 statistical software. The p-value <0.05 was considered statistically significant. Result: About 83 patients (86.46%) were in NOM group while 13 patients (13.54%) were in OM group. The most common age group involved was 6-12 years with male predominance. Median age was 9.2 years. The most common mechanism of injury was road traffic accident 31 (32.29%). Among 84 patients with isolated solid organ injury, only 5 (5.9%) required surgical intervention. Among nine patients with isolated hollow viscous injury, 5 (55.5%) required surgical intervention. All 3 (100%) patients with both hollow viscous and solid organ injury required surgery. Hypotension and blood transfusion requirement were statistically significant factors in the OM group p<0.05. Complications, length of hospital and ICU stay were more in operatively managed group with mortality rate of 1.04%. Conclusion: The success of NOM of blunt trauma abdomen depends on proper selection of the patient. Patients who are haemodynamically stable can be safely managed non operatively with adequate monitoring in a tertiary care centre.

Keywords

• child
• conservative treatment
• injuries
• laparotomy
• trauma centre