500 - Risk Factors for Traumatic Pancreatitis in Children
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 500 Publication Number: 500.311
Matthew Marks, Jacobi Medical Center, New York, NY, United States; James Meltzer, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
Pediatric Emergency Medicine Fellow Jacobi Medical Center New York, New York, United States
Background: Traumatic pancreatitis is a rare and dangerous injury that is often missed on initial evaluation in the emergency department (ED). Though uncommon, traumatic pancreatitis is associated with high rates of morbidity and mortality. There is limited data on the diagnosis of traumatic pancreatitis in children. Objective: The aim of this study is to develop a diagnostic tool for traumatic pancreatitis, using only historical and physical exam findings initially available to the clinician in the ED. Design/Methods: This was a retrospective cohort study utilizing a publicly available, de-identified dataset collected by the Pediatric Emergency Care Applied Research Network (PECARN). The dataset included 12,044 patients < 18 years old who presented to the ED with blunt abdominal injury.The main outcome was pancreatitis identified on CT imaging, surgical exploration, or post-mortem analysis. Demographic and clinical risk factors were evaluated for association with pancreatic injury using bivariate analysis. Variables with statistically significant associations in bivariate analysis were then used to build a prediction model for traumatic pancreatitis using logistic regression. Results: Of the 12,044 children presenting with blunt abdominal trauma, 7,384 (61%) were males and the median age was 11 years (IQR, 5-15 years). There were 761 (6%) patients with an intra-abdominal injury, of which 51 (6%) had a pancreatic injury. Compared to those without pancreatic injury, children with traumatic pancreatitis were more likely to be hospitalized (51 [100%] vs 5,940 [50%], p< 0.001), require surgical intervention (19 [37%] vs 113 [1%], p< 0.001), or die within 30 days of injury (7 [14%] vs 93 [1%], p< 0.001). Six variables were found to be independently associated with pancreatic injury: hypotension (aOR, 6.1; 95% CI, 2.3-15.9), evidence of abdominal wall injury on exam (aOR,3.8; 95% CI, 2.1-6.9), history of handlebar injury (aOR,3.3; 95% CI, 1.3-8.1),abdominal tenderness (aOR,3.1; 95% CI, 1.5-6.4), vomiting (aOR,4.0; 95% CI, 2.2-7.3), and requiring intubation (aOR,9.0; 95% CI, 3.9-21). In total, 47 patients (93%; 95% CI, 80-97%) with pancreas injuries had at least one of these findings.
Conclusion(s): Patients presenting to the ED for blunt abdominal trauma found to have hypotension, abdominal wall injury, handlebar injury, abdominal tenderness, vomiting, or are intubated appear to be at highest risk for pancreatic injury. Identifying these risk factors in the ED may lead to the earlier detection of pancreatic injury, which has the potential to reduce morbidity and mortality.
