Research Article | DOI: https://doi.org/10.31579/2690-4861/1189
Clinic of Pediatric Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine “N. I. Pirogov”, Sofia, Bulgaria.
*Corresponding Author: Ivan Vasilevski, MD, Clinic of Pediatric Surgery, UMHATEM “N. I. Pirogov”, 21 Gen. Eduard I. Totleben Blvd., 1606 Sofia, Bulgaria.
Citation: I. Vasilevski, (2026), Blunt Pancreatic Trauma in Children: A Single-Center Experience and Factors Influencing Management, International Journal of Clinical Case Reports and Reviews, 38(1); DOI:10.31579/2690-4861/1189
Copyright: © 2026, I. Vasilevski. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 09 October 2026 | Accepted: 23 October 2026 | Published: 30 October 2026
Keywords: blunt pancreatic trauma; children; main pancreatic duct; nonoperative management; operative management
Background: Blunt pancreatic trauma in children is uncommon and presents diagnostic and therapeutic challenges, particularly in injuries involving the main pancreatic duct (MPD). This study describes a single-center experience with nonoperative and operative management, focusing on factors influencing treatment decisions and clinical outcomes.
Methods: We retrospectively reviewed 16 consecutive children with blunt pancreatic trauma treated at the Clinic of Pediatric Surgery, UMHATEM “N. I. Pirogov”, between January 2019 and September 2025. Injury mechanism and AAST-OIS grade, imaging findings, treatment strategies, complications, and hospital length of stay were analyzed descriptively.
Results: Mean age was 9.3 years (range, 4–16 years); 14 patients (87.5%) were boys. Bicycle-related trauma was the leading mechanism of injury (68.8%). According to the AAST-OIS, 7 patients (43.8%) had grade II injuries, 7 (43.8%) had grade III injuries, 1 (6.3%) had a grade IV injury, and 1 (6.3%) had a grade V injury. Nonoperative management was used in 11/16 patients (68.8%), including 3 with grade III and 1 with grade IV injuries. Pancreatic pseudocysts developed in 3/11 patients (27.3%); 2 underwent endoscopic transgastric drainage and 1 resolved spontaneously, with none requiring subsequent surgery. Operative treatment was performed in 5/16 patients (31.3%): 4 with grade III and 1 with grade V injuries. In 4 patients, surgery was undertaken after 1–7 days of clinical and imaging observation because of clinical deterioration and/or progression of imaging findings. Distal pancreatectomy was performed in 4 patients, with splenic preservation in 2; 1 patient underwent a Traverso–Longmire pancreaticoduodenectomy. No clinically significant postoperative pancreatic fistulas or reoperations were observed.
Conclusions: Children with pancreatic injuries of the same AAST grade may require different therapeutic strategies. Nonoperative management can avoid pancreatic resection in selected patients, although delayed complications may necessitate prolonged hospitalization or endoscopic intervention. Treatment decisions should incorporate injury morphology, suspected MPD involvement, and evolving clinical and imaging findings rather than AAST grade alone.
Traumatic injuries of the pancreas are rare in children but represent a significant diagnostic and therapeutic challenge. Published series report rates ranging from 0.4% to 12% among children with blunt abdominal trauma, although most large pediatric series report rates of approximately 2–5%. High-grade injuries account for a relatively small but clinically significant proportion of cases [1–4].
In contrast to liver and splenic trauma, for which nonoperative management (NOM) is widely accepted in hemodynamically stable children, the optimal management of pancreatic trauma, particularly high-grade injuries, remains controversial [5–7].
Diagnosis may be challenging because of the retroperitoneal location of the pancreas, the nonspecific early clinical presentation, and the limited sensitivity of initial imaging studies for detecting main pancreatic duct (MPD) injury. MPD integrity is one of the key factors in assessing injury severity and selecting the therapeutic approach. Other important considerations include the location and extent of parenchymal injury, associated intra-abdominal injuries, and the evolution of clinical and imaging findings [6,7].
The American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) provides a standardized morphological assessment of pancreatic trauma. The 2024 revision places greater emphasis on MPD integrity and further refines the role of anatomical location in the classification of high-grade injuries [8]. Nevertheless, the AAST grade primarily reflects the anatomical characteristics of the injury and should not be regarded as a stand-alone treatment algorithm. Patients with similar morphological grades may follow different clinical courses and require different management strategies.
NOM is widely accepted for low-grade pancreatic injuries. The major therapeutic dilemma arises in high-grade injuries (AAST III–V), for which management continues to vary among centers [5–7,9]. Systematic analyses indicate that NOM can also be successful in selected patients with high-grade injuries, although it is associated with a higher incidence of local pancreatic complications, most commonly pseudocysts. Conversely, operative management (OM) may provide definitive control for selected parenchymal and ductal injuries but is associated with surgical morbidity and loss of functional pancreatic parenchyma [5,6].
Recent evidence suggests that framing the clinical problem simply as “operative” versus “nonoperative” management may be overly simplistic. A 2025 meta-analysis including 17 observational studies and 1,147 patients found no significant difference in mortality or overall complication rates between the two approaches. NOM was associated with a higher risk of pancreatic pseudocyst, whereas operative management was associated with a higher risk of pancreatic fistula. However, the certainty of the available evidence was rated as very low, precluding the formulation of a universal therapeutic algorithm [10].
Despite recent advances in the management of pediatric pancreatic trauma, important uncertainties remain regarding the selection of operative versus nonoperative treatment, particularly in high-grade injuries involving the main pancreatic duct. Recent prospective multicenter evidence supports standardized nonoperative management in selected children with ductal injuries, while systematic reviews continue to emphasize the limited certainty of comparative evidence. However, the influence of injury location, ductal involvement, and evolving clinical and imaging findings on subsequent therapeutic decisions remains insufficiently defined [11].
The aim of the present study was to analyze our single-center experience with blunt pancreatic trauma in children, focusing on the factors influencing the initial choice and subsequent modification of the therapeutic strategy, as well as treatment-related outcomes and complications. Particular attention was given to the different clinical courses and therapeutic decisions observed among children with similar AAST injury grades.
This retrospective, single-center study included all 16 consecutive pediatric patients treated for pancreatic trauma at the Clinic of Pediatric Surgery, UMHATEM “N. I. Pirogov”, between January 2019 and September 2025. All patients sustained blunt pancreatic injuries. No eligible patients were excluded from the analysis.
Demographic characteristics, mechanism of injury, associated injuries, laboratory parameters, imaging findings, morphological characteristics of the pancreatic injury, therapeutic approach, interventional and surgical procedures, complications, and clinical outcomes were retrospectively analyzed. Pancreatic injuries were categorized according to the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS), based on the available clinical, imaging, and operative findings. Injury classification was based on the location and extent of parenchymal injury, as well as the available evidence of MPD involvement.
Diagnostic assessment included clinical observation, laboratory testing, and imaging studies. In patients managed nonoperatively, serum amylase was measured on admission, whereas serum lipase was not routinely assessed. Imaging included Focused Assessment with Sonography for Trauma (FAST) and contrast-enhanced computed tomography (CECT), both performed in all patients managed nonoperatively. Magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRI/MRCP) were used selectively. MPD status was assessed based on the available CT and MRI/MRCP findings and, in surgically treated patients, also on intraoperative findings.
According to the treatment ultimately received, patients were divided into two groups: those managed nonoperatively and those treated surgically. NOM was initiated in hemodynamically stable patients without an immediate indication for surgical intervention, provided that close clinical and imaging follow-up could be ensured.In the operative group, the interval between admission and surgical intervention was also analyzed, together with the clinical and imaging factors that prompted a change from the initial management strategy.
According to the treatment ultimately received, patients were divided into two groups: those managed nonoperatively and those treated surgically. Treatment decisions were individualized according to the patient's hemodynamic status, injury morphology and location, available evidence of main pancreatic duct involvement, associated injuries, and the evolution of clinical and imaging findings. Nonoperative management was initially undertaken in hemodynamically stable patients without an immediate indication for surgery, provided that close clinical and imaging follow-up was feasible. The decision to proceed with surgical intervention, either immediately or after an initial period of observation, was based on the overall clinical condition, the anatomical characteristics of the injury, and changes observed during follow-up. In surgically treated patients, the interval between admission and surgical intervention and the factors prompting a change in the initial management strategy were also analyzed. No predefined institutional treatment algorithm was applied.
A total of 16 patients aged 4–16 years were included in the analysis. The mean age was 9.3 years. Fourteen patients (87.5%) were boys and two (12.5%) were girls. All injuries resulted from blunt trauma. Bicycle-related trauma was the most common mechanism of injury, accounting for 69% of cases. The remaining injuries resulted from falls, road traffic accidents, and other mechanisms of blunt abdominal trauma. Associated intra-abdominal or extra-abdominal injuries were identified in 4 patients (25%). The main characteristics of the study population are presented in Table 1.
According to the AAST-OIS, 7 patients (43.8%) had grade II injuries, 7 (43.8%) had grade III injuries, 1 (6.3%) had a grade IV injury, and 1 (6.3%) had a grade V injury (Table 2).
| Characteristic | Result |
| Number of patients | 16 |
| Age, years, range (mean) | 4–16 (9.3) |
| Boys | 14 (87.5%) |
| Girls | 2 (12.5%) |
| Blunt trauma | 16 (100%) |
| Bicycle-related trauma | 11 (68.8%) |
| Associated injuries | 4 (25.0%) |
| Nonoperative management | 11 (68.8%) |
| Operative management | 5 (31.3%) |
Table 1: Main characteristics of the study population
| AAST grade | Total | NOM | OM |
| II | 7 | 7 | 0 |
| III | 7 | 3 | 4 |
| IV | 1 | 1 | 0 |
| V | 1 | 0 | 1 |
| Total | 16 | 11 | 5 |
Table 2: Distribution according to AAST grade and treatment approach
Patients were categorized according to the definitive treatment received. Of the 16 children, 11 were managed without surgery, whereas 5 underwent operative treatment. Among the surgically treated patients, 4 initially underwent clinical and imaging observation before surgical intervention became necessary.
NOM was undertaken in 11 of 16 patients (68.8%). Their ages ranged from 4 to 13 years, with a mean age of 8.4 years. Bicycle- or scooter-related injuries predominated in this group. One patient was referred to our department after initial treatment at another institution.
Serum amylase was measured on admission in all patients in this group. Admission values showed considerable variability and no clear relationship with the morphological grade of injury. During follow-up, some patients demonstrated a secondary rise in serum amylase levels that coincided with more pronounced clinical or imaging changes.
FAST and CECT were performed in all patients in this group, whereas MRI/MRCP was used selectively.
Pancreatic pseudocysts developed in 3 of 11 patients (27.3%) and were the most common complication among children managed nonoperatively. Two patients underwent endoscopic internal drainage of pancreatic collections using transgastric and transduodenal approaches, respectively, whereas spontaneous resolution occurred in the third patient. (Figure 1). None of these patients subsequently required surgical intervention.
Figure 1a–b. Post-traumatic pancreatic pseudocyst and its endoscopic drainage. (a) Pancreatic pseudocyst (arrow). (b) Endoscopic transgastric view of internal drainage of the pseudocyst
Operative management was performed in 5 of 16 patients (31.3%), including 4 with AAST grade III injuries and 1 with a grade V injury. One patient underwent immediate surgery because of the complexity of the pancreaticoduodenal injury. In the remaining 4 patients, surgical intervention was undertaken after an initial observation period of 1–7 days. The decision to proceed with surgery was based on individualized clinical assessment, including deterioration in the patient's general condition, findings suggestive of septic complications, and progression of pathological changes on follow-up CT examinations.
Distal pancreatectomy was performed in 4 of 5 patients (80%), with splenic preservation in 2 (Figures 2 and 3). One 5-year-old child with an AAST grade V injury involving both the duodenum and the pancreatic head underwent a Traverso–Longmire pancreaticoduodenectomy.
Figure 2: CT image of a patient with an AAST III pancreatic injury
Figure 3a–b: Intraoperative findings during distal pancreatectomy
Postoperatively, abscess collections were observed in 1 patient and a localized intra-abdominal collection in another. Pleural effusion developed following pancreaticoduodenectomy in the patient with an associated liver injury. No clinically significant postoperative pancreatic fistulas or reoperations were recorded.
The median initial hospital stay was 8 days (range, 6–36 days) in the nonoperative group and 15 days (range, 12–17 days) in the operative group. One patient in the nonoperative group required a prolonged continuous hospitalization of 36 days, during which endoscopic transduodenal drainage of a pancreatic collection with stent placement was performed. Another patient developed a pancreatic pseudocyst requiring two subsequent hospitalizations for endoscopic transgastric drainage and later stent removal, resulting in a cumulative hospital stay of 21 days. When documented readmissions were included, the median cumulative hospital stays in the nonoperative group remained 8 days (range, 6–36 days).
In contrast to liver and splenic trauma, in pancreatic injuries hemodynamic stability alone is insufficient to determine the appropriate therapeutic approach [3,12–14].
The lack of randomized comparative studies and the substantial heterogeneity of published series account for the absence of a universally accepted treatment algorithm for high-grade pancreatic injuries in children [5,7,15].
In the present study, 11 of 16 patients (68.8%) were managed nonoperatively, including 3 children with AAST grade III and 1 with grade IV injuries. This is consistent with the growing evidence that a high AAST grade alone does not constitute an absolute indication for surgery in a hemodynamically stable child. In the systematic review by Koh et al., NOM was initially used in 46% of children with AAST grade III–V injuries and was successful in 89% of these patients [5]. The multicenter study by Naik-Mathuria et al. also demonstrated that high-grade injuries can be managed nonoperatively, although considerable variability in management was observed among pediatric trauma centers [9]. The meta-analysis by Kopljar et al. reported an overall success rate of 87% for initial NOM, although early operative management may retain potential advantages in high-grade injuries involving the MPD [16].
The group of patients with AAST grade III injuries is particularly illustrative in the present series. Of the 7 children with grade III injuries, 3 were managed nonoperatively, whereas 4 underwent surgical intervention following an initial observation period of 1–7 days. The decision to operate was based on clinical deterioration, findings suggestive of septic complications, and progression of pathological changes on follow-up CT examinations. Although the small number of patients precludes identification of independent predictors of treatment failure, these observations illustrate the variability of clinical courses within the same AAST grade and underscore the importance of individualized reassessment during treatment.
The integrity of the main pancreatic duct (MPD) remains a key consideration in the management of pediatric pancreatic trauma. Disruption of ductal integrity is associated with the risk of persistent leakage of pancreatic secretions, peripancreatic collections, pseudocysts, fistulas, and infectious complications. The importance of ductal injury is further emphasized in the 2024 revision of the AAST-OIS, which places greater emphasis on MPD integrity and refines the anatomical characterization of high-grade injuries [8].
Assessment of MPD integrity, however, remains challenging. CECT is the primary initial imaging modality in hemodynamically stable patients, but early imaging may underestimate parenchymal injury and does not always permit reliable direct assessment of ductal integrity [13,14]. In the present series, CT was the primary imaging modality, whereas MRI/MRCP was used selectively. Progression of CT findings observed in some of the surgically treated patients further emphasizes the importance of serial imaging when the initial morphological findings are discordant with the clinical course. MRCP may provide additional information when MPD status remains uncertain, whereas ERCP allows direct assessment of the duct and provides the opportunity for simultaneous therapeutic intervention in selected patients [15, 17-18]. In the multicenter study by Rosenfeld et al., ERCP was used selectively and either altered management or contributed to improved outcomes in approximately half of the patients who underwent the procedure, whereas early stenting or sphincterotomy did not demonstrate a clear benefit in terms of recovery [15]. Therefore, when MPD status is uncertain, imaging findings should be interpreted in conjunction with the morphology of the parenchymal injury and the clinical course.
One of the main concerns with NOM for high-grade injuries is the higher incidence of local pancreatic complications, including peripancreatic collections and pseudocysts [5,9,10,16]. Pancreatic pseudocyst formation was the most common complication of nonoperative management in our series, occurring in 3 of 11 patients (27.3%). Two patients required endoscopic internal drainage of pancreatic collections, whereas spontaneous resolution was observed in the third. None subsequently required surgical intervention. These findings highlight an important distinction between the development of a local complication and failure of nonoperative management. Although pseudocyst formation may necessitate additional intervention, successful treatment using minimally invasive techniques can allow definitive surgical management to be avoided. Therefore, the need for endoscopic drainage should not necessarily be interpreted as failure of the initial nonoperative strategy. Rather, it may represent a subsequent stage of treatment within a broader nonoperative management approach. In the systematic review by Koh et al., pseudocysts were more common following NOM, but approximately two-thirds were also successfully managed without surgical intervention [5]. Multicenter data indicate that management of organized post-traumatic collections may include observation, percutaneous drainage, or endoscopic procedures [9].
Although the median initial hospital stay was shorter in the nonoperative group (8 vs. 15 days), this finding does not necessarily indicate a lower overall treatment burden. Delayed pancreatic complications may require additional hospitalizations, endoscopic interventions, and prolonged follow-up. In our series, one patient required a continuous 36-day hospitalization, while another accumulated 21 hospital days across three admissions. These observations highlight the distinction between successful avoidance of surgery and the cumulative burden of treatment. Given the small sample size and differences in injury severity, the observed differences in hospital stay should be interpreted descriptively rather than as evidence of superiority of either management strategy.
Surgical management was required in 5 of 16 patients in our series. Distal pancreatectomy was performed in 4 children with AAST grade III injuries, with splenic preservation achieved in 2 cases. These patients underwent surgery after an initial observation period, emphasizing that the need for operative intervention may become apparent during follow-up rather than at initial presentation. In distally located high-grade injuries, resection represents an established option for the management of severe parenchymal and ductal disruption. In children, preservation of the spleen is desirable whenever permitted by the anatomy of the injury and the patient’s condition because of its important immunological function.
One child with an AAST grade V injury involving the pancreatic head and duodenum required immediate pancreaticoduodenectomy using the Traverso–Longmire technique. Such extensive procedures are rarely necessary in pediatric pancreatic trauma and are generally reserved for highly complex injuries in which the extent of pancreaticoduodenal damage precludes less extensive surgical management. This case illustrates the exceptional circumstances in which major pancreatic resection may be required, rather than supporting its routine use in high-grade pancreatic injuries.
Nonoperative and Operative Management: Different Morbidity Profiles
Recent evidence further illustrates the ongoing controversy regarding the optimal management of pediatric pancreatic trauma. A 2025 systematic review and meta-analysis including 17 observational studies and 1,147 children found no statistically significant differences in mortality or overall complication rates between nonoperative and operative management. However, nonoperative management was associated with a higher incidence of pancreatic pseudocysts (OR 2.56; 95% CI 1.55–4.23), whereas the risk of pancreatic fistula was lower (OR 0.27; 95% CI 0.11–0.69). Importantly, the certainty of evidence for all evaluated outcomes was rated as very low [10].
Our findings are consistent with the heterogeneous clinical courses described in the literature. However, the small sample size, differences in injury severity, and individualized selection of treatment preclude meaningful comparisons between the two management strategies. Rather than demonstrating the superiority of either approach, our observations support the importance of considering injury morphology, clinical evolution, and the potential complications associated with each treatment strategy when making therapeutic decisions.
In this context, considering operative and nonoperative management as two mutually exclusive strategies may oversimplify the actual clinical process. A more appropriate concept is that of an individualized and dynamic management strategy, in which the initial decision may subsequently be modified or supplemented by endoscopic, interventional, or surgical procedures according to the evolving clinical course.
In a hemodynamically stable child without an immediate indication for surgery, initial observation offers the possibility of preserving pancreatic parenchyma but requires close clinical and imaging follow-up. Conversely, an unfavorable clinical course, development of infectious complications, progression of imaging findings, or injury morphology that precludes safe organ-preserving management may necessitate modification of the initial strategy. The different clinical courses observed among patients with AAST grade III injuries in the present series specifically support this dynamic approach.
This study has several limitations. First, its retrospective, single-center design and small sample size limit the generalizability of the findings. Second, the heterogeneity of injury severity and the individualized selection of treatment introduce potential selection bias and preclude reliable comparisons between nonoperative and operative management. Third, MRI/MRCP was performed selectively rather than systematically, which may have limited the uniform assessment of main pancreatic duct involvement. Finally, the small number of patients and clinical heterogeneity did not permit meaningful inferential statistical analysis or the identification of independent predictors of treatment outcomes. Despite these limitations, the study provides a detailed description of clinical decision-making in a consecutive series of children with blunt pancreatic trauma, particularly the circumstances leading to modification of the initial management strategy.
The management of blunt pancreatic trauma in children requires an individualized approach based on injury severity, anatomical location, suspected or confirmed main pancreatic duct involvement, and the evolution of clinical and imaging findings. Although the AAST classification provides a useful framework for assessing injury severity, it should not be used as the sole determinant of treatment.
Our experience demonstrates that children with injuries of the same AAST grade may follow different clinical courses and require different therapeutic strategies. Nonoperative management can be successful in selected patients, including those who develop complications amenable to endoscopic treatment, while surgical intervention may become necessary following an initial period of observation. Continuous clinical reassessment and timely modification of the treatment strategy remain essential components of management.
Abbreviations: MPD, main pancreatic duct; AAST grade, American Association for the Surgery of Traumagrade; AAST-OIS, AAST-Organ Injury Scale; NOM, nonoperative management; OM, operative management; CT, computed tomography; MRI/MRCP, Magnetic resonance imaging and magnetic resonance cholangiopancreatography; FAST, Focused Assessment with Sonography for Trauma; ERCP, Endoscopic Retrograde Cholangiopancreatography.
Ethics approval. Ethical review was not required for this study in accordance with local regulations.
Informed consent. Written informed consent for publication of this study and the accompanying images was obtained from the patient’s parents.
Author contributions. Assoc. Prof. Ivan Vasilevski conceived the report, performed the operation, collected and interpreted the clinical data, reviewed the literature, and wrote and approved the final manuscript.
Funding. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest. The author declares no conflict of interest.
Data availability. The data supporting the findings of this study are contained within the article. Further information is available from the corresponding author upon reasonable request.
Acknowledgement. The author thanks radiology for its contribution to the diagnostic process.
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Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
