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Updated: May 20, 2026
Robot-assisted Partial Splenectomy
Published on: January 2, 2026
Management of pediatric blunt splenic injury at a rural trauma center
Julio J Bird1, Nirav Y Patel, Michelle A Mathiason
1Department of General and Vascular Surgery, Gundersen Lutheran Health System, La Crosse, Wisconsin, USA.
Insights
Pediatric blunt splenic injuries (BSIs) can be successfully managed nonoperatively in adult trauma centers. Routine follow-up imaging is not necessary, with a 100% splenic injury salvage rate in this study.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Emergency Medicine
Background:
- Nonoperative management of pediatric blunt splenic injuries (BSIs) lacks standardized protocols.
- Unclear indications for repeated imaging and activity restrictions exist.
- The impact of trauma center type on BSI outcomes is not well-defined.
Purpose of the Study:
- To evaluate the efficacy and outcomes of nonoperative management for pediatric BSIs in an adult Level II trauma center.
- To determine the necessity of routine follow-up imaging in these patients.
- To assess the overall splenic injury salvage rate.
Main Methods:
- Retrospective review of pediatric patients (<16 years) with BSIs from 1995-2008.
- Analysis of injury grade, hemoperitoneum, imaging findings (CT), hemoglobin levels, blood transfusion, and clinical outcomes.
- Data collected on length of stay, disposition, follow-up, and return to activity.
Main Results:
- 97% of 38 pediatric BSIs were successfully managed nonoperatively.
- Median splenic injury grade was 3, with 73% having moderate-to-large hemoperitoneum.
- No late complications or need for intervention from follow-up imaging were observed; 100% splenic salvage rate.
Conclusions:
- Adult trauma centers can effectively manage pediatric BSIs with outcomes comparable to pediatric centers.
- Routine follow-up imaging after nonoperative management of pediatric BSIs is not essential.
- High splenic injury salvage rates are achievable in this setting.
Background:
Patterns for nonoperative management of pediatric blunt splenic injuries (BSIs) vary significantly within and between institutions. The indications for repeated imaging, duration of activity restrictions, as well as the impact of volume and type of trauma center (pediatric vs. adult) on outcomes remain unclear.
Methods:
A retrospective review of all patients younger than 16 years with BSI managed at a rural American College of Surgeons-verified adult Level II trauma center from January 1995 to December 2008 was completed. Patients were identified from the trauma registry by DRG International Classification of Diseases-9th Rev. (865.00-865.09) and management codes (41.5, 41.43, and 41.95). Variables reviewed included demographics, mechanism of injury, Injury Severity Score, grade of splenic injury, degree of hemoperitoneum, presence of arterial phase contrast blush on computed tomography at admission, admission and nadir hemoglobin level, blood transfused, length of stay, disposition, outpatient clinical and radiographic follow-up, interval of return to unrestricted activity, and clinical outcomes.
Results:
During the 13-year study period, 38 children with BSI were identified. Thirty-seven (97%) were successfully managed nonoperatively. Median grade of splenic injury was 3 (range, 1-5); 73% had moderate-to-large hemoperitoneum. Median Injury Severity Score was 10 (range, 4-34). Three patients with isolated contrast blush on initial computed tomography were successfully managed nonoperatively with no angiographic intervention. One patient failed nonoperative management and underwent successful splenorrhaphy. All patients were discharged home. Thirty-day mortality was zero. Median follow-up duration was 5.5 years, with no late complications identified. Of the patients successfully managed nonoperatively, 92% had their follow-up at our institution; 74% underwent subsequent imaging, and none resulted in intervention or alteration of management plan.
Conclusion:
Pediatric BSI can be managed in adult trauma centers with success rates of nonoperative management comparable to dedicated children's hospitals. Routine follow-up imaging is not necessary. Overall splenic injury salvage rate in our experience was 100%.
Level Of Evidence:
Therapeutic/epidemiologic study, level IV.
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