Hazards of nonoperative therapy of hepatic injury in children

Several reports suggest that pediatric patients with stable liver injuries can be managed nonoperatively with few complications. From March 1978 to July 1983 seven children with hepatic injury were managed without surgery at CHNMC. Four children required greater than 50% total blood volume replacement, while the mean PRBC transfusion rate was 28 cc/kg. Eight major complications developed in five patients. Hospitalization averaged 23 days, without a mortality. This morbidity is greater than that described in earlier reports. In view of the limited cumulative clinical experience, we caution against routine nonoperative management of liver trauma in children until data with this new technique become available for analysis.