Multiple trauma: liver and spleen injury

Area of Science:

• Pediatric surgery
• Trauma management
• Abdominal injuries

Background:

• Management of pediatric hepatic and splenic injuries has shifted from operative to nonoperative approaches over 30 years.
• Nonoperative management strategies are becoming standardized, but areas for refinement remain.
• Falls from greater heights are a significant cause of solid organ injury in children.

Purpose of the Study:

• To review and refine nonoperative management strategies for pediatric hepatic and splenic injuries.
• To address ongoing debates regarding optimal care settings (adult vs. pediatric trauma centers).
• To clarify the risk of post-splenectomy sepsis.

Main Methods:

• Analysis of the Pennsylvania Trauma Systems Foundation dataset for children with severe liver injuries.
• Literature review to clarify the risk of post-splenectomy sepsis.
• Examination of factors influencing nonoperative management, including ICU/acute care length of stay, laboratory draws, activity restriction, and radiographic healing evidence.

Main Results:

• Nonoperative management is now the predominant strategy for the majority of pediatric hepatic and splenic injuries.
• Specific parameters of nonoperative care, such as length of stay and activity restrictions, require further study.
• The risk of post-splenectomy sepsis has been further elucidated.

Conclusions:

• Nonoperative management is the established standard for pediatric hepatic and splenic injuries.
• Continued research is necessary to optimize intensive care unit (ICU) and acute care unit lengths of stay, laboratory testing frequency, activity restriction duration, and radiographic healing criteria.
• Understanding the risks associated with splenectomy remains crucial.