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Ruptured spleen due to blunt trauma in children: analysis of blood transfusion requirements
N Kiliç1, A Gürpinar, I Kiriştioğlu
1Department of Paediatric Surgery, Medical Faculty of Uludag University, Görükle, Bursa, Turkey.
Insights
Selective non-operative management is safe for pediatric splenic injuries. Strict conservative protocols can reduce blood transfusions in children with blunt splenic trauma, even with isolated injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Pediatric Emergency Medicine
Background:
- Selective non-operative management (SNOM) is a recognized approach for pediatric splenic injuries.
- Most isolated splenic injuries in children do not necessitate blood transfusions.
Purpose of the Study:
- To evaluate the safety and outcomes of selective non-operative management for pediatric splenic trauma.
- To assess the rate of blood transfusion in children undergoing conservative management for blunt splenic injuries.
Main Methods:
- Retrospective review of 84 children treated for blunt splenic trauma between 1988 and 1997.
- Analysis of management strategies including non-operative care, splenectomy, and splenorraphy.
- Evaluation of transfusion requirements and associated complications.
Main Results:
- Non-operative management was employed in 66.7% of cases, with no reported late complications.
- Overall mortality was 9.5%, primarily associated with additional intra-abdominal or systemic injuries.
- In the non-operative group, 57.1% received blood transfusions, with some receiving minimal amounts.
Conclusions:
- Selective non-operative management is a safe and effective strategy for pediatric splenic injuries.
- Strict adherence to conservative management protocols can significantly reduce blood transfusion rates.
- Further refinement of transfusion criteria may further decrease blood product utilization in this cohort.
Abstract:
Selective non-operative management of splenic injury in children is generally considered to be safe, and the majority of those with isolated injuries do not require blood transfusion. Eighty-four children were treated for blunt splenic trauma from 1988 to 1997 in the Department of Paediatric Surgery, The Medical Faculty of Uludag University, Bursa, Turkey. Management involved non-operative care in 56 cases (66.7%), splenectomy in 20 (23.8%) and splenorraphy in eight (9.5%) cases. There were no later complications related to splenic injury. The overall mortality was 9.5% (8/84) and the factors effecting mortality were additional intra-abdominal and/or other system injuries. Twenty-two children were not transfused during non-operative treatment. In our study, only 57.1% of the children in the non-operative group received blood transfusions. Some of the patients in this group received only small amounts of blood and probably would have recovered without it. It is concluded that, based on a very strict protocol in conservative management, the total amount of transfused blood could be reduced in children with splenic injuries due to blunt abdominal trauma.
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