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DOI: 10.1055/s-0031-1273692
© Georg Thieme Verlag KG Stuttgart · New York
Blunt Splenic Trauma in Children: Are We Too Careful?
Publication History
received December 24, 2010
accepted after revision January 29, 2011
Publication Date:
14 March 2011 (online)

Abstract
Introduction: There has been a shift from operative treatment (OT) to non-operative treatment (NOT) of splenic injury. We evaluated the outcomes of treatment of pediatric patients with blunt splenic trauma in our hospital, with special focus on the outcomes after NOT.
Patients and Methods: The data of all patients <18 years with radiologically proven blunt splenic injury admitted between 1988 and 2007 were retrospectively analyzed. Mechanism of injury, type of treatment, ICU stay, total hospital stay, morbidity and mortality were assessed. Patients suffering isolated splenic injuries were assessed separately from patients with multiple injuries. Patients were subsequently divided into those admitted before and after 2000.
Results: There were 64 patients: 49 males and 15 females with a mean age of 13 years (range 0–18). 3 patients died shortly after admission due to severe neurological injury and were excluded. In the remaining 61 patients concomitant injuries, present in 62%, included long bone fractures (36%), chest injuries (16%), abdominal injuries (33%) and head injuries (30%). Mechanisms of injury were: car accidents (26%), motorcycle (20%), bicycle (19%), fall from height (17%) and pedestrians struck by a moving vehicle (8%). A change in treatment strategy was evident for the pre- and post-2000 periods. Significantly more patients had NOT after 2000 in both the isolated splenic injury group and the multi-trauma group [4/11 (36%) before vs. 10/11 (91%) after (p=0.009); 15/19 (79%) before vs. 8/20 (40%) after 2000 (p=0.03)]. There was also a significant shift to spleen-preserving operations. All life-threatening complications occurred within <24 h after injury. Mortality for the entire cohort was 7%; all of these patients were treated operatively. When comparing the median ICU and hospital stay before and after 2000 it was found to be significantly higher in the isolated injury group and remained statistically the same in the multi-trauma group.
Conclusion: Splenic injury in children is associated with substantial mortality. This is due to concomitant injuries and not to the splenic injury. Non-operative treatment is increasingly preferred to operative procedures when treating splenic injuries in hemodynamically, stable children. ICU and hospital stay have, despite the change from OT to NOT, remained the same. Complications after NOT are rare. We are still observing children in hospital for a longer period than is necessary.
Key words
splenic injury - non operative treatment - length of stay
References
- 1
Stylianos S.
Compliance with evidence-based guidelines in children with isolated spleen or liver
injury: a prospective study.
J Pediatr Surg.
2002;
37
453-456
MissingFormLabel
- 2
Stylianos S.
Evidence-based guidelines for resource utilization in children with isolated spleen
or liver injury.
J Pediatr Surg.
2000;
35
164-167
MissingFormLabel
- 3
Tataria M, Nance ML, Holmes 4th JH. et al .
Pediatric blunt abdominal injury: age is irrelevant and delayed operation is not detrimental.
J Trauma.
2007;
63
608-614
MissingFormLabel
- 4
Davies DA, Pearl RH, Ein SH. et al .
Management of blunt splenic injury in children: evolution of the nonoperative approach.
J Pediatr Surg.
2009;
44
1005-1008
MissingFormLabel
- 5
Delius RE, Frankel W, Coran AG.
A comparison between operative and nonoperative management of blunt injuries to the
liver and spleen in adult and pediatric patients.
Surgery.
1989;
106
788-792
MissingFormLabel
- 6
Nellensteijn D, Porte RJ, Zuuren WV. et al .
Pediatric blunt liver trauma in a Dutch level 1 trauma center.
Eur J Pediatr Surg.
2009;
19
358-361
MissingFormLabel
- 7
McVay MR, Kokoska ER, Jackson RJ. et al .
Throwing out the “grade” book: management of isolated spleen and liver injury based
on hemodynamic status.
J Pediatr Surg.
2008;
43
1072-1076
MissingFormLabel
- 8
Leinwand MJ, Atkinson CC, Mooney DP.
Application of the APSA evidence-based guidelines for isolated liver or spleen injuries:
a single institution experience.
J Pediatr Surg.
2004;
39
487-490
MissingFormLabel
- 9
Bauchner H, Simpson L, Chessare J.
Changing physician behaviour.
Arch Dis Child.
2001;
84
459-462
MissingFormLabel
- 10
Bowman SM, Bulger E, Sharar SR. et al .
Variability in pediatric splenic injury care.
Arch Surg.
2010;
145
(11)
1048-1053
MissingFormLabel
- 11
Lutz N, Mahboubi S, Nance ML. et al .
The significance of contrast blush on computed tomography in children with splenic
injuries.
J Pediatr Surg.
2004;
39
491-494
MissingFormLabel
- 12
Nwomeh BC, Nadler EP, Meza MP. et al .
Contrast extravasation predicts the need for operative intervention in children with
blunt splenic trauma.
J Trauma.
2004;
56
537-541
MissingFormLabel
- 13
McCray VW, Davis JW, Lemaster D. et al .
Observation for nonoperative management of the spleen: how long is long enough?.
J Trauma.
2008;
65
1354-1358
MissingFormLabel
- 14
Grandić L, Pogorelić Z, Banović J. et al .
Advantages of the spared surgical treatment of the spleen injuries in the clinical
conditions.
Hepatogastroenterology.
2008;
55
2256-2258
MissingFormLabel
- 15
Godbole P, Stringer MD.
Splenectomy after paediatric trauma: could more spleens be saved?.
Ann R Coll Surg Engl.
2002;
84
106-108
MissingFormLabel
Correspondence
Dr. Jan B. F. HulscherMD, PhD
University Medical Center
Groningen
Pediatric Surgery
Hanzeplein 1
9700RB Groningen
Netherlands
Phone: + 31 50 361 2306
Fax: + 31 50 361 1745
Email: J.B.F.Hulscher@chir.umcg.nl