Splenic injuries in children: correlation between imaging and clinical management

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S Al-Shanafey1, M Giacomantonio, R Jackson

  • 1Department of Surgery, Dalhousie University, IWK Grace Health Centre, Halifax, Nova Scotia, Canada.

Pediatric Surgery International
|August 31, 2001
PubMed

Insights

Non-operative management of pediatric splenic injuries shows hospital stay is linked to age, hemoglobin, and ICU duration. Follow-up imaging did not alter clinical decisions for these trauma cases.

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.

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