Splenic injuries in children: correlation between imaging and clinical management

Area of Science:

• Pediatric Surgery
• Trauma Management
• Diagnostic Imaging

Background:

• Non-operative management (NOM) is standard for pediatric splenic injuries, but optimal practices for imaging, hospital stay, and follow-up require clarification.
• Previous studies have not fully elucidated the factors influencing outcomes in children undergoing NOM for splenic trauma.

Purpose of the Study:

• To review a 15-year experience with pediatric splenic injuries managed non-operatively.
• To analyze factors influencing hospital stay and mortality.
• To evaluate the utility of follow-up imaging in NOM of splenic injuries.

Main Methods:

• Retrospective chart review of pediatric patients (<16 years) with splenic injuries from 1983-1998.
• Computed tomography (CT) scans were reviewed and graded.
• Statistical analysis included Fisher's exact test and linear regression.

Main Results:

• Of 92 children, 57% had CT scans; 6.5% died. Hospital stay (median 8 days) correlated with age, admission hemoglobin, and ICU stay.
• Motor vehicle-pedestrian injuries significantly correlated with mortality.
• CT classification did not correlate with mortality or hospital stay. Follow-up imaging did not impact clinical decisions or reveal late sequelae.

Conclusions:

• Hospital stay in pediatric splenic injuries is multifactorial, influenced by patient and initial treatment variables, not solely injury grade on CT.
• Routine follow-up imaging after NOM for pediatric splenic injuries appears unnecessary and does not alter clinical management.
• Focusing on initial patient factors and injury mechanism is crucial for predicting outcomes in pediatric splenic trauma.