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Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline
Brent Zabolotny1, B J Hancock, Ray Postuma
1Department of Surgery, Children's Hospital of Winnipeg, Man.
Insights
Nonoperative management of pediatric splenic injuries can be optimized by reducing intensive care unit admissions and hospital stays. Omitting follow-up imaging and allowing earlier activity can improve care efficiency and patient recovery.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injury
Background:
- Blunt splenic injuries are common in children.
- Current management protocols vary, impacting patient outcomes and healthcare resource utilization.
Purpose of the Study:
- To review current practice patterns for pediatric splenic injuries at a Canadian center.
- To develop an evidence-based, safe, and effective care plan for nonoperative management.
Main Methods:
- Retrospective chart review of pediatric patients (<17 years) with splenic injuries.
- Data collected included demographics, injury grade (using American Association for the Surgery of Trauma Organ Injury Scale), management, length of stay, and follow-up protocols.
Main Results:
- Forty-four children managed nonoperatively had a mean age of 10.4 years and injury grade of 2.8.
- Average length of stay was 9.2 days, with 36% admitted to the ICU. Follow-up imaging did not alter management.
- Median time to full activity was 12 weeks, with one case of delayed hemorrhage requiring splenectomy.
Conclusions:
- Nonoperative management of pediatric splenic injuries can be improved by decreasing ICU admissions and hospital length of stay.
- Standardizing care, omitting routine follow-up imaging, and facilitating earlier return to activity can enhance efficiency and safety.
Objectives:
To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries.
Design:
A chart review.
Setting:
Winnipeg Children's Hospital.
Patients:
All patients with splenic injuries under the age of 17 years admitted to the hospital between December 1994 and April 1999.
Outcome Measures:
These included patient demographics, length of stay, location of care, grade of splenic injury (American Association for the Surgery of Trauma Organ Injury Scale), imaging tests performed in hospital and after discharge, follow-up care and time to return to full activity.
Results:
Forty-four patients received nonoperative management. The mean age of the patients was 10.4 years. The average grade of splenic injury was 2.8. Sixteen patients (36%) were admitted to the intensive care unit for an average of 1.9 days. Mobilization was allowed after a mean of 5.2 days. Average length of hospital stay was 9.2 days. At the time of admission 98% of the patients underwent computed tomography, but at follow-up only 20% of patients underwent this investigation. None of the follow-up imaging studies altered the postdischarge management plan. The median time to full activity was 12 weeks (range from 0-17 wk). One patient had a delayed hemorrhage and required splenectomy.
Conclusions:
Reduced admissions to the intensive care unit, shorter overall stays, omission of follow-up imaging and an earlier return to full activity should be considered in the management of children with blunt splenic injuries. Standardization of nonoperative care for such children would result in safe and more efficient delivery of health care.