Management of pediatric high-grade blunt hepatic trauma at adult and pediatric trauma centers: An analysis of the TQIP database.

Abstract

Previous data suggest that there may be increased use of invasive interventions for pediatric blunt solid organ injury at nonpediatric trauma centers. In pediatric high-grade (AAST Grades III-V) blunt hepatic injuries (BHI), specifically, previous single-center and state-level studies have demonstrated that presentation to adult trauma centers independently predicts increased use of angioembolization and hemorrhage control laparotomy, but this observation has not been validated using a large, nationwide dataset. This study evaluated the use of invasive interventions (hemorrhage control laparotomy and/or hepatic angioembolization) and mortality in children with BHI across pediatric, adult, and hybrid trauma centers (PTCs, ATCs, and HTCs). We retrospectively reviewed children aged 17 and below, with high-grade BHI (AAST Grades III-V, defined by AIS) in the ACS Trauma Quality Improvement Program database from 2017 to 2022. Univariate analyses compared demographics, injury characteristics, management strategies, and outcomes between ATCs, HTCs, and PTCs. Backward stepwise regression evaluated predictors of hemorrhage control laparotomy, angioembolization, and mortality. In total, 5,498 children were included. Children presenting to an ATC were older (p<0.01). There was no difference in the distribution of Grade III, IV, or V injuries between center types (p=0.50). On univariate analyses, PTC-presentation was associated with lower injury severity score, higher rates of isolated injury, lower rates of positive shock index, and lower rates of early blood transfusion (p<0.01). ATC-presentation was associated with higher rates of hepatic angioembolization (ATC: 2.7%, HTC: 1.8%, PTC: 1.0%, p<0.01), hemorrhage control laparotomy (ATC: 3.3%, HTC: 2.3%, PTC: 1.1%, p<0.01), and mortality (ATC: 7.1%, HTC: 5.0%, PTC: 3.2%, p<0.01). However, on regression analysis, trauma center verification status did not independently predict angioembolization, hemorrhage control laparotomy, or mortality. Contrary to prior data in smaller populations, in this national analysis of high-grade pediatric blunt hepatic trauma, hospital verification status did not independently influence the likelihood of hepatic angioembolization, hemorrhage control laparotomy, or mortality. Cohort Study; Level III.