weekly_question 1/8/2021

[Admin]

A 10 year old boy was struck in the left upper abdomen after falling from a bike. CT scan shows a Grade 2 liver and Grade 3 spleen injury. What follow up imaging should be performed? Based on the new APSA guidelines you recommend:

A No imaging

B Chest X ray

C Ultrasound

D CT scan

E MRI

[Admin]

correct answer
A No imaging

Management of pediatric solid organ injuries differs from similar traumatic lesions in adults, with a much higher incidence of non operative management and splenic salvage. However, there was noted to be a wide variation in how these patients were being managed in terms of the hospital length of stay, ICU utilization, repeat use of imaging, and activity restrictions. The injury grade is used to help guide these decisions, and remains an important part of any guidelines. Multiple studies noted the safety of an abbreviated course of hospital and ICU stay based on the grade and the hemodynamic stability. In 2019, APSA published a new set of solid organ injury guidelines based on a systematic review of the literature. They suggested the following:

The hospital (and ICU) length of stay should be determined by clinical findings primarily, taking the grade of injury into consideration
Post discharge activity limitation can be injury grade plus two weeks (limited data), although less may be safe
There should be no role for prophylactic arterial embolization based on image-confirmed extravasation if there is no clinical evidence of ongoing bleeding
Routine follow up imaging for asymptomatic and uncomplicated lower grade injuries is not warranted (and limited evidence exists for subsequent imaging in high grade injuries)
These guidelines will hopefully help in reducing variability and resource utilization for blunt traumatic solid organ injuries in children. In the scenario described, with uncomplicated relatively low grade injuries there is no need for any further post discharge imaging based on the guidelines and systematic review.

[m.alabood]

D - CT Scan 24 to 48 hours later

[Ahmednabilps]

C

[Admin]

correct answer
A No imaging

Management of pediatric solid organ injuries differs from similar traumatic lesions in adults, with a much higher incidence of non operative management and splenic salvage. However, there was noted to be a wide variation in how these patients were being managed in terms of the hospital length of stay, ICU utilization, repeat use of imaging, and activity restrictions. The injury grade is used to help guide these decisions, and remains an important part of any guidelines. Multiple studies noted the safety of an abbreviated course of hospital and ICU stay based on the grade and the hemodynamic stability. In 2019, APSA published a new set of solid organ injury guidelines based on a systematic review of the literature. They suggested the following:

The hospital (and ICU) length of stay should be determined by clinical findings primarily, taking the grade of injury into consideration
Post discharge activity limitation can be injury grade plus two weeks (limited data), although less may be safe
There should be no role for prophylactic arterial embolization based on image-confirmed extravasation if there is no clinical evidence of ongoing bleeding
Routine follow up imaging for asymptomatic and uncomplicated lower grade injuries is not warranted (and limited evidence exists for subsequent imaging in high grade injuries)
These guidelines will hopefully help in reducing variability and resource utilization for blunt traumatic solid organ injuries in children. In the scenario described, with uncomplicated relatively low grade injuries there is no need for any further post discharge imaging based on the guidelines and systematic review.

[Admin]

[Brian Opondo]

no imaging