The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review

Cornelis H. van der Vlies; Teun P. Saltzherr; Jim C. H. Wilde; Otto M. van Delden; Rob J. de Haan; J. Carel Goslings

doi:https://doi.org/10.1016/j.jpedsurg.2010.01.002

The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review

Cornelis H. van der Vlies, Teun P. Saltzherr, Jim C. H. Wilde, Otto M. van Delden, Rob J. de Haan, J. Carel Goslings

Research output: Contribution to journal › Review article › Academic › peer-review

48 Citations (Scopus)

Abstract

Purpose: Nonoperative management (NOM) is the treatment of choice for hemodymically stable pediatric patients with spleen or liver trauma. The aim of this study was to assess the failure rate of NOM in children with blunt liver and/or splenic injury when a contrast blush is present on a computed tomography (CT) scan. Methods: A systematic review of the literature published between 1985 and 2009 was performed by searching the EMBASE and MEDLINE database for English and German articles. Articles were eligible if they reported the failure rate of NOM with or without angioembolization (AE) in pediatric patients with splenic and/or liver injuries with a contrast blush on CT and included 2 or more trauma patients. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. Interrater differences were resolved by discussion. Results: Nine studies were included describing 117 pediatric patients. The median sample size was 5 (range, 2-44). Seven studies (including 71 patients) reported a total of 16 patients with failure after NOM without AE. Failure rates across these studies ranged from 4.5% to 100%; the pooled percentage was 28.2% (95% confidence interval, 8.9%-61.3%). The failure percentages after NOM with or without AE ranged from 0 to 100%; the pooled percentage was 21% (95% confidence interval, 7.5%-46.8%). Two studies (including 46 patients) reported a total of 3 patients (6.5%) with failure after NOM with primary AE. Conclusion: Despite the current low level of evidence on failure rate of NOM when a contrast blush is present on CT, we emphasize that there is a significant number of patients in whom NOM fails. We therefore recommend that the management of splenic and hepatic injury in children should not only be based on the physiologic response but should include consideration of the presence of a contrast blush. Crown Copyright (C) 2010 Published by Elsevier Inc. All rights reserved

Original language	English
Pages (from-to)	1044-1049
Journal	Journal of Pediatric Surgery
Volume	45
Issue number	5
DOIs	https://doi.org/10.1016/j.jpedsurg.2010.01.002
Publication status	Published - 2010

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https://doi.org/10.1016/j.jpedsurg.2010.01.002

Cite this

@article{ad754538456145b68ed6fe221aa83bbd,

title = "The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review",

abstract = "Purpose: Nonoperative management (NOM) is the treatment of choice for hemodymically stable pediatric patients with spleen or liver trauma. The aim of this study was to assess the failure rate of NOM in children with blunt liver and/or splenic injury when a contrast blush is present on a computed tomography (CT) scan. Methods: A systematic review of the literature published between 1985 and 2009 was performed by searching the EMBASE and MEDLINE database for English and German articles. Articles were eligible if they reported the failure rate of NOM with or without angioembolization (AE) in pediatric patients with splenic and/or liver injuries with a contrast blush on CT and included 2 or more trauma patients. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. Interrater differences were resolved by discussion. Results: Nine studies were included describing 117 pediatric patients. The median sample size was 5 (range, 2-44). Seven studies (including 71 patients) reported a total of 16 patients with failure after NOM without AE. Failure rates across these studies ranged from 4.5% to 100%; the pooled percentage was 28.2% (95% confidence interval, 8.9%-61.3%). The failure percentages after NOM with or without AE ranged from 0 to 100%; the pooled percentage was 21% (95% confidence interval, 7.5%-46.8%). Two studies (including 46 patients) reported a total of 3 patients (6.5%) with failure after NOM with primary AE. Conclusion: Despite the current low level of evidence on failure rate of NOM when a contrast blush is present on CT, we emphasize that there is a significant number of patients in whom NOM fails. We therefore recommend that the management of splenic and hepatic injury in children should not only be based on the physiologic response but should include consideration of the presence of a contrast blush. Crown Copyright (C) 2010 Published by Elsevier Inc. All rights reserved",

author = "{van der Vlies}, {Cornelis H.} and Saltzherr, {Teun P.} and Wilde, {Jim C. H.} and {van Delden}, {Otto M.} and {de Haan}, {Rob J.} and Goslings, {J. Carel}",

year = "2010",

doi = "https://doi.org/10.1016/j.jpedsurg.2010.01.002",

language = "English",

volume = "45",

pages = "1044--1049",

journal = "Journal of Pediatric Surgery",

issn = "0022-3468",

publisher = "W.B. Saunders Ltd",

number = "5",

}

The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. / van der Vlies, Cornelis H.; Saltzherr, Teun P.; Wilde, Jim C. H. et al.
In: Journal of Pediatric Surgery, Vol. 45, No. 5, 2010, p. 1044-1049.

Research output: Contribution to journal › Review article › Academic › peer-review

TY - JOUR

T1 - The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review

AU - van der Vlies, Cornelis H.

AU - Saltzherr, Teun P.

AU - Wilde, Jim C. H.

AU - van Delden, Otto M.

AU - de Haan, Rob J.

AU - Goslings, J. Carel

PY - 2010

Y1 - 2010

N2 - Purpose: Nonoperative management (NOM) is the treatment of choice for hemodymically stable pediatric patients with spleen or liver trauma. The aim of this study was to assess the failure rate of NOM in children with blunt liver and/or splenic injury when a contrast blush is present on a computed tomography (CT) scan. Methods: A systematic review of the literature published between 1985 and 2009 was performed by searching the EMBASE and MEDLINE database for English and German articles. Articles were eligible if they reported the failure rate of NOM with or without angioembolization (AE) in pediatric patients with splenic and/or liver injuries with a contrast blush on CT and included 2 or more trauma patients. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. Interrater differences were resolved by discussion. Results: Nine studies were included describing 117 pediatric patients. The median sample size was 5 (range, 2-44). Seven studies (including 71 patients) reported a total of 16 patients with failure after NOM without AE. Failure rates across these studies ranged from 4.5% to 100%; the pooled percentage was 28.2% (95% confidence interval, 8.9%-61.3%). The failure percentages after NOM with or without AE ranged from 0 to 100%; the pooled percentage was 21% (95% confidence interval, 7.5%-46.8%). Two studies (including 46 patients) reported a total of 3 patients (6.5%) with failure after NOM with primary AE. Conclusion: Despite the current low level of evidence on failure rate of NOM when a contrast blush is present on CT, we emphasize that there is a significant number of patients in whom NOM fails. We therefore recommend that the management of splenic and hepatic injury in children should not only be based on the physiologic response but should include consideration of the presence of a contrast blush. Crown Copyright (C) 2010 Published by Elsevier Inc. All rights reserved

AB - Purpose: Nonoperative management (NOM) is the treatment of choice for hemodymically stable pediatric patients with spleen or liver trauma. The aim of this study was to assess the failure rate of NOM in children with blunt liver and/or splenic injury when a contrast blush is present on a computed tomography (CT) scan. Methods: A systematic review of the literature published between 1985 and 2009 was performed by searching the EMBASE and MEDLINE database for English and German articles. Articles were eligible if they reported the failure rate of NOM with or without angioembolization (AE) in pediatric patients with splenic and/or liver injuries with a contrast blush on CT and included 2 or more trauma patients. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. Interrater differences were resolved by discussion. Results: Nine studies were included describing 117 pediatric patients. The median sample size was 5 (range, 2-44). Seven studies (including 71 patients) reported a total of 16 patients with failure after NOM without AE. Failure rates across these studies ranged from 4.5% to 100%; the pooled percentage was 28.2% (95% confidence interval, 8.9%-61.3%). The failure percentages after NOM with or without AE ranged from 0 to 100%; the pooled percentage was 21% (95% confidence interval, 7.5%-46.8%). Two studies (including 46 patients) reported a total of 3 patients (6.5%) with failure after NOM with primary AE. Conclusion: Despite the current low level of evidence on failure rate of NOM when a contrast blush is present on CT, we emphasize that there is a significant number of patients in whom NOM fails. We therefore recommend that the management of splenic and hepatic injury in children should not only be based on the physiologic response but should include consideration of the presence of a contrast blush. Crown Copyright (C) 2010 Published by Elsevier Inc. All rights reserved

U2 - https://doi.org/10.1016/j.jpedsurg.2010.01.002

DO - https://doi.org/10.1016/j.jpedsurg.2010.01.002

M3 - Review article

C2 - 20438952

SN - 0022-3468

VL - 45

SP - 1044

EP - 1049

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

IS - 5

ER -