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Current management of blunt splenic trauma in children

Stephen R Thompson1, Andrew J A Holland

  • 1Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Sydney, NSW 2145, Australia.

ANZ Journal of Surgery
|February 18, 2006
PubMed

Insights

Most children with blunt splenic trauma can be safely treated without intensive care unit (ICU) admission. Follow-up imaging and activity restrictions beyond 3-4 weeks are generally not necessary for pediatric splenic injuries.

Area of Science:

  • Pediatric Trauma Surgery
  • Abdominal Trauma Management

Background:

  • Non-operative management is standard for most pediatric blunt splenic injuries.
  • Guidelines for intensive care unit (ICU) admission, follow-up imaging, and activity restrictions remain debated.
  • This study reviews current practices in a major Australian pediatric trauma center.

Purpose of the Study:

  • To define current practices for managing blunt splenic trauma in children.
  • To evaluate the necessity of ICU admission, repeat imaging, and prolonged activity restrictions.

Main Methods:

  • Retrospective chart review of pediatric patients with splenic trauma.
  • Data collected from November 1995 to December 2003 at The Children's Hospital at Westmead.
  • Analysis of management strategies, imaging, ICU utilization, and outcomes.

Main Results:

  • 39 patients with blunt splenic trauma were identified; 85% managed non-operatively.
  • Computed tomography was the primary imaging modality (72%).
  • 14% admitted to ICU; mean length of stay (LOS) 10.8 days. No deaths, but 10 complications. Mean activity restriction was 7.4 weeks.

Conclusions:

  • The majority of pediatric blunt splenic trauma cases are safely managed non-operatively without ICU admission.
  • Repeated imaging in stable patients does not appear beneficial.
  • Activity restrictions exceeding 3-4 weeks are likely unwarranted.
Abstract

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