The management of blunt pancreatic injury in children in New South Wales

Background Blunt pancreatic injury is uncommon but associated with considerable morbidity. The optimal management strategy for children with this injury remains unclear, with laparotomy rates in North America of up to 55%. This has not been studied at a population level in Australia. This study aimed to examine the management of children with blunt pancreatic injury in New South Wales (NSW), Australia. Methods Using the NSW Admitted Patient Data Collection from 2001 to 2019, we identified patients <16 years old with blunt pancreatic injury. Cases were categorised as undergoing non-operative or operative management. Patient and injury characteristics and outcomes were compared between non-operative and operative groups. Independent predictors of operative management were identified using multivariable logistic regression. Results 139 cases were identified: 37 (26.6%) underwent operative management, of whom 11 (29.7%) had a pancreas-specific operation. Two-thirds were managed at a paediatric trauma centre. Operation rates were highest in adult trauma centres, although treatment outside a paediatric trauma centre overall was not associated with operative management. Independent predictors of operative management were high-grade pancreatic injury, hollow viscus injury and transfusion. Morbidity and mortality were 30.2% and 1.4%, respectively. Conclusion Blunt pancreatic injury continues to carry substantial morbidity. Operation rates in NSW are lower than those reported in North America, with similar outcomes. Unlike other solid organ injuries, most children are managed at paediatric trauma centres. Future studies should investigate factors driving management decisions in the Australian context, with the aim of developing paediatric guidelines promoting non-operative management. Highlights Operation rates for children with BPI were much lower than reported in international studies, with comparable morbidity and lower mortality. Operation rates were highest at ATCs, although, overall, children with BPI managed outside PTCs were not more likely to undergo an operation. Penetrating pancreatic injury is rare compared to the US, likely reflecting that firearm-related injury in Australia remains uncommon. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: NSW Population and Health Services Research Ethics Committee gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors