Utility of radiographic hepatic injury grade in predicting outcome for children after blunt abdominal trauma

David J. Hackam, Douglas Potoka, Manuel Meza, Avrum Pollock, Mary Gardner, Peter Abrams, Jeffrey Upperman, Laura Schall, Henri Ford

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Background/Purpose: The American Association for the Surgery of Trauma (AAST) liver injury grading system has been adopted in the management of pediatric hepatic injuries. However, the usefulness of this grading system in children remains undefined. The authors, therefore, examined the validity of AAST grading in the management of pediatric blunt liver injury. Methods: The authors identified 152 patients, ages 0 to 18 years, with blunt hepatic injury treated at our pediatric trauma center between 1995 and 2000. Radiographic AAST grade was assigned retrospectively by 2 radiologists. Variables analyzed included age, gender, Glasgow Coma Score (GCS), Injury Severity Score (ISS), and associated injuries. Outcome measures were mortality rate and length of stay (LOS). Statistical analysis was performed using analysis of variance or linear regression. Results: Computed tomography (CT) scans were available for 95 patients. Radiographic injury grade did not correlate with mortality rate, hospital LOS or intensive care unit (ICU) LOS. ISS and associated injury, but not age, gender, or GCS, were predictive of LOS. Grade did not correlate with mortality rate, ICU LOS, or hospital LOS. Conclusions: Radiographic liver grading does not predict outcome reliably in children and should not be the main parameter utilized to guide clinical decision making. A role for scoring systems that utilize factors such as associated injuries and ISS is indicated.

Original languageEnglish (US)
Pages (from-to)386-389
Number of pages4
JournalJournal of Pediatric Surgery
Volume37
Issue number3
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

Keywords

  • Blunt trauma
  • Hepatic injury
  • Injury grading
  • Pediatric trauma
  • Trauma outcomes

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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