Management of high-grade splenic injury in children

Jeffrey Jim, Michael J. Leonardi, H. Gill Cryer, Jonathan R. Hiatt, Stephen Shew, Marilyn Cohen, Areti Tillou

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Using the National Trauma Databank, we identified 413 children (age ≤ 14 years) who sustained high-grade blunt splenic injury (Abbreviated Injury Scale scores ≥4) from 2001 to 2005. Overall mortality was 13.5 per cent. Early operation within 6 hours of injury (EOM) was performed in 128 patients (31%). Patients not undergoing EOM (n = 285) were assumed to have been treated with initial nonoperative management (NOM). NOM was successful in 84 per cent of patients. Operative intervention was necessary in 42 per cent of cases with 74 per cent of these undergoing early operation (EOM). Total splenectomy was the most common procedure (83%). EOM and failure of NOM were both associated with lower systolic blood pressure and lower Glasgow Coma Scale score at admission, higher Injury Severity Score, longer hospital stay, and higher mortality. Need for surgery was independent of patient age and gender. Failure of NOM was associated with increased mortality compared with successful NOM, but had similar mortality and length of hospital or intensive care unit stay compared with EOM. We conclude that operative treatment is necessary in nearly half of pediatric patients with high-grade splenic injury. With careful selection, nonoperative management is usually successful but must include close monitoring, because 16 per cent required delayed operation.

Original languageEnglish
Pages (from-to)988-992
Number of pages5
JournalAmerican Surgeon
Volume74
Issue number10
StatePublished - Oct 1 2008
Externally publishedYes

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