Harwood, R 
ORCID: 0000-0003-3440-3142, Bethell, G, Eastwood, MP, Hotonu, S, Allin, B, Boam, T, Rees, CM, Hall, NJ, Rhodes, H, Ampirska, T et al (show 37 more authors)
(2023)
The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres.
EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY, 49 (5).
pp. 2249-2256.
Abstract
<h4>Purpose</h4>To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.<h4>Methods</h4>UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.<h4>Results</h4>All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic.<h4>Conclusions</h4>UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Trauma, Pediatric, Blunt injury, Liver Spleen |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 08 Jul 2022 13:58 |
| Last Modified: | 17 Oct 2023 17:25 |
| DOI: | 10.1007/s00068-022-01990-3 |
| Open Access URL: | https://link.springer.com/article/10.1007/s00068-0... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3158017 |
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