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- Background: Current guidelines recommend exploratory laparotomy for pediatric patients with abdominal firearm injuries. Recent research in adults suggests that laparoscopy may be preferable in selected populations. This study compared clinical outcomes of hemodynamically stable pediatric patients with abdominal firearm injuries that were managed with laparoscopy versus laparotomy.
Methods: A retrospective study was conducted using the Pediatric Trauma Quality Improvement Program database. Pediatric patients with abdominal firearm injuries from 2010 to 2020 were sorted into laparotomy (n = 1806) and laparoscopy (n = 48) groups using ICD-9 and ICD-10 procedure codes. Primary outcomes were rates of complications and infections. Secondary outcomes included transfusions, mortality, ICU admission, hospital length of stay (LOS), and ICU LOS. Data were analyzed in a similar fashion to an intention-to-treat principle.
Results: Laparoscopy was associated with younger mean age (13.4 years versus 15.6 years, p = 0.02) and higher mean GCS (13.8 versus 12.6, p = 0.03); no significant difference was found in sex or mean ISS. Complication rates were significantly lower in the laparoscopy group (21.1% versus 4.2%, odds ratio [OR] 0.16 [0.02, 0.63], p = 0.002), but there was no significant difference between rates of infection. Laparoscopy was associated with fewer ICU stays (62.5% versus 77.4%, OR 0.49, [0.26, 0.94], p = 0.02) and transfusions (35.4% versus 57.1%, OR 0.41, [0.21, 0.78], p = 0.003); there was no significant difference in mortality rate, mean LOS, or mean ICU LOS.
Conclusions: Laparoscopic management of abdominal firearm injuries in hemodynamically stable patients is associated with lower rates of complications, transfusions, and ICU stay. The results from this study merit a larger prospective trial to evaluate the difference in outcomes associated with an initial laparoscopic approach in hemodynamically stable pediatric patients with abdominal firearm injuries.
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