Pediatric abdominal injury: initial treatment and diagnostics

David Nellensteijn

    Research output: ThesisThesis fully internal (DIV)

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    Abstract

    We have demonstrated that the inter- and intra-observer variation for grading of liver injury using CT scan is significant. This makes CT not suitable for defining treatment guidelines. Subsequently we have demonstrated that CT scan has a very limited diagnostic yield in the hemodynamically stable child, and should be avoided, as radiation risks are substantial. Injury scoring systems such as BATiC score, just as serum markers such as Fatty Acid Binding Proteins, might aid in the decision whether or not to obtain a CT scan. There is an increased awareness of the inherent dangers of CT scan, and we now often refrain from CT scan in the hemodynamically stable child – even in the presence of free fluid on ultrasound. In general, non-operative management in pediatric abdominal injury is safe. There should be a large index of suspicion for pancreatic injury, which is easily missed in the acute phase, and repeat examinations including blood analysis should be performed in every child with a possible pancreatic injury. Hospital stay can be shortened for virtually all children with intra-abdominal parenchymatous injury-at least in our center.
    There is no evidence for routine one week of bed rest for children with splenic or hepatic injury. Updated protocols for primary analysis, initial treatment and follow-up, including protocols for transferring of injured pediatric patients, should be composed and validated by both specialized and referral centers Such protocols will reduce time, avoid needless investigations and prevent harmful radiation. From such collaboration all injured children will benefit.
    Translated title of the contributionBuikletsel bij kinderen: primaire behandeling en diagnostiek
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • ten Duis, Hendrik, Supervisor
    • Duits, Ashley, Supervisor
    • Hulscher, Jan, Co-supervisor
    Award date1-Apr-2015
    Place of Publication[S.l.]
    Publisher
    Print ISBNs978-94-6169-632-8
    Publication statusPublished - 2015

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