The management of blunt pancreatic injury in children in New South Wales

Abstract

AbstractBackgroundBlunt pancreatic injury is uncommon but associated with considerable morbidity. The optimal management strategy for children with this injury remains unclear, with laparotomy rates in North America of up to 55%. This has not been studied at a population level in Australia. This study aimed to examine the management of children with blunt pancreatic injury in New South Wales (NSW), Australia.MethodsUsing the NSW Admitted Patient Data Collection from 2001 to 2019, we identified patients <16 years old with blunt pancreatic injury. Cases were categorised as undergoing non-operative or operative management. Patient and injury characteristics and outcomes were compared between non-operative and operative groups. Independent predictors of operative management were identified using multivariable logistic regression.Results139 cases were identified: 37 (26.6%) underwent operative management, of whom 11 (29.7%) had a pancreas-specific operation. Two-thirds were managed at a paediatric trauma centre. Operation rates were highest in adult trauma centres, although treatment outside a paediatric trauma centre overall was not associated with operative management. Independent predictors of operative management were high-grade pancreatic injury, hollow viscus injury and transfusion. Morbidity and mortality were 30.2% and 1.4%, respectively.ConclusionBlunt pancreatic injury continues to carry substantial morbidity. Operation rates in NSW are lower than those reported in North America, with similar outcomes. Unlike other solid organ injuries, most children are managed at paediatric trauma centres. Future studies should investigate factors driving management decisions in the Australian context, with the aim of developing paediatric guidelines promoting non-operative management.HighlightsOperation rates for children with BPI were much lower than reported in international studies, with comparable morbidity and lower mortality.Operation rates were highest at ATCs, although, overall, children with BPI managed outside PTCs were not more likely to undergo an operation.Penetrating pancreatic injury is rare compared to the US, likely reflecting that firearm-related injury in Australia remains uncommon.