Predicting hollow visceral injury in the pediatric blunt trauma patient with solid visceral injury

Background: Nonoperative management of a solid organ injury (SVI) is accepted in the stable pediatric trauma patient. A concern with nonoperative management is missing a hollow visceral injury (HVI). Factors that may help predict HVI have not been well documented. Methods: The National Pediatric Trauma Registry was reviewed for the period October 1988 through September 1998 for all blunt injured, hemodynamically stable pediatric patients (age ≤12 years) with an SVI (kidney, liver, pancreas, spleen) of Abbreviated Injury Scale (AIS) score ≥2. HVIs included AIS ≥2 gastrointestinal tract injuries. Results: For the decade of review, 2,977 pediatric patients sustained an SVI, including 96 with an HVI (3.2%). The mean age was 6.6 years, with a mean Injury Severity Score of 12.4. An occupant in a motor vehicle accident was the most common injury mechanism (30.4%), but assault was the most likely to result in an HVI (11.5%). The liver was the most common SVI (n = 1,400), the spleen the least likely to have an associated HVI (2.5%). Pancreatic injuries had a higher rate of HVI (P