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Management of blunt pediatric hepatic and splenic injury: similar process, different outcome
Heather N Paddock1, Joseph J Tepas, Max L Ramenofsky
1Department of Surgery, University of Florida Health Science Center Jacksonville, Jacksonville, Florida 32209, USA.
Insights
Hepatic injuries in children carry a higher mortality risk than splenic injuries. Combined liver and spleen injuries significantly increase mortality potential, especially with increasing injury severity.
Area of Science:
- Pediatric Trauma Surgery
- Abdominal Solid Organ Injury
Background:
- Nonoperative management is effective for stable pediatric blunt solid organ injuries.
- Hepatic and splenic injuries are common blunt abdominal trauma in children.
- The comparative mortality risk of isolated hepatic vs. splenic injuries is not well-defined.
Purpose of the Study:
- To compare the mortality risk of isolated hepatic injuries versus isolated splenic injuries in children.
- To evaluate the mortality associated with combined hepatic and splenic injuries.
- To identify factors influencing mortality in pediatric blunt liver and spleen trauma.
Main Methods:
- Retrospective analysis of a multi-institutional pediatric trauma registry.
- Inclusion of children with blunt liver (H) or spleen (S) injuries, excluding severe brain injury.
- Comparison of incidence and mortality rates for isolated H, isolated S, and combined H/S injuries.
Main Results:
- Hepatic injuries (2.5% mortality) had significantly higher mortality than splenic injuries (0.7% mortality).
- Combined hepatic/splenic injuries demonstrated a significantly higher overall mortality rate (8.6%).
- Mortality in combined injuries correlated with increased severity of either hepatic or splenic trauma.
Conclusions:
- Hepatic injuries pose a greater mortality risk than splenic injuries in pediatric blunt trauma.
- Combined hepatic and splenic injuries represent a marker for significantly increased mortality potential.
- Injury severity is a critical factor in the outcomes of combined hepatosplenic trauma.
Abstract:
Though nonoperative management of stable children with blunt solid organ injury has been shown to be effective, we hypothesize that hepatic injuries represent a higher mortality risk than splenic injuries and that combination hepatosplenic injury is a marker of even greater mortality potential. A multi-institutional pediatric trauma registry was queried for all children with blunt injuries to the liver (H) or spleen (S), excluding those with severe brain injury. Incidence and mortality of H, S, and all combinations of H/S were compared. The mortality rate for patients with H was significantly higher (2.5%) than in patients with S (0.7%), and the overall mortality of H/S (8.6%) was significantly higher than both. Furthermore, the mortality of H/S injuries was associated with increasing severity of either the hepatic or splenic injury. In childhood injury, H and S occur with almost equal frequency but with different mortality, and H/S is less common but associated with increased mortality.
