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[Evolution in the management of splenic trauma. Retrospective study in children]
J Correia-Pinto1, J Estevão-Costa
1Departamento de Pediatria, Hospital de São João, Porto.
Insights
Conservative management of blunt splenic lesions in children is effective, significantly reducing splenectomies without increasing transfusions. This approach is viable, though hospital stays may be longer.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Surgical Outcomes
Background:
- Blunt splenic lesions management has shifted towards conservative approaches.
- Portuguese national data on this therapeutic shift were previously unavailable.
Purpose of the Study:
- To evaluate the outcomes of conservative management for blunt splenic lesions in Portuguese children.
- To compare surgical versus conservative treatment strategies.
Main Methods:
- Retrospective analysis of 54 pediatric patients with blunt splenic lesions over 7 years.
- Comparison of a surgical group (1990-1992) with a conservative management group (1993-1996).
- Studied variables included age, sex, associated lesions, treatment, blood transfusion needs, and hospital stay.
Main Results:
- Conservative management drastically reduced splenectomies (13% vs. 97% in the surgical group).
- Blood transfusion requirements and associated lesions were similar between groups.
- Associated lesions did not significantly impact conservative treatment effectiveness.
- Hospital stay was significantly longer in the conservative group (12.5 days vs. 9.8 days).
Conclusions:
- Conservative management is a viable and effective approach for most pediatric blunt splenic lesions.
- This strategy significantly decreases the need for splenectomy.
- While transfusion rates remain stable, a longer hospital stay is a consideration.
Background/Purpose:
The treatment of blunt splenic lesions had changed in the last years with an increasing trend to conservative management. In the absence of national surveys, this paper is aimed to evaluate the results of this therapeutic approach in a group of Portuguese children.
Materials And Methods:
Patients with blunt splenic lesions, admitted over a period of 7 years, (n = 54) were retrospectively analysed. A group submitted to surgical treatment 'ab initio' (group A, from 1990 to 1992 incl.) was compared with a group managed by a conservative approach (group B, from 1993 to 1996 inclusive). Age, sex, associated lesions, treatment, need of a blood transfusion and length of hospital stay were studied.
Results:
The frequency of splenic lesions was relatively stable (6 to 10 years) in both periods. Group A (n = 24) was similar to group B (n = 30) regarding gender and age. In group A, 23 (97%) splenectomies were performed. In group B, only six (20%) children underwent laparotomy and 4 (13%) of them were submitted to splenectomy (A vs. B, p < 0.001). The need of a blood transfusion was similar in the two groups and so were the associated lesions. The great majority of transfused children presented associated lesions (10/11, 91%). In group B, associated lesions did not significantly alter the effectiveness of the conservative treatment. Hospital stay was significantly longer in group B (B vs. A: 12.5 +/- 2.5 vs. 9.8 +/- 1.8, p = 0.017).
Conclusions:
The conservative approach was viable in the great majority of patients with blunt splenic lesions, resulting in a drastic reduction in splenectomies. The need for transfusions did not increase, but the length of hospital stay increased. These results are concordant with other series from major centres, justifying this approach and constituting the challenge of its application in adults.