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Evolution in the management of splenic injury in children
K P Lally1, V Rosario, G H Mahour
1Department of Surgery, Childrens Hospital, Los Angeles, California.
Insights
Management of splenic trauma in children has evolved, with a significant shift towards nonoperative treatment in recent decades. While nonoperative care is preferred, surgery remains necessary for some patients, maintaining high splenic salvage rates.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injuries
Background:
- Splenic trauma is a common consequence of blunt abdominal injuries in children.
- Historically, surgical management, primarily splenectomy, was the standard approach for splenic injuries.
Purpose of the Study:
- To evaluate the evolving treatment strategies for pediatric splenic trauma over a 20-year period.
- To compare outcomes between operative and nonoperative management of splenic injuries in children.
Main Methods:
- Retrospective chart review of 111 pediatric patients with splenic injury from 1965-1985.
- Analysis of treatment approaches (splenectomy, splenorrhaphy, nonoperative management) and patient outcomes.
- Comparison of management strategies between two distinct decades (1965-1975 and 1976-1985).
Main Results:
- A marked increase in nonoperative management of splenic trauma was observed in the second decade (73% vs 0%).
- Patients treated nonoperatively experienced fewer complications and required less blood products compared to surgically treated patients.
- The overall survival rate was 95%, with associated injuries being the cause of mortality, not the splenic trauma itself.
Conclusions:
- Nonoperative management is effective for the majority of pediatric splenic injuries.
- Surgical intervention, including splenorrhaphy and splenectomy, remains crucial for approximately 38% of patients.
- High splenic salvage rates (85%) can be achieved with appropriate management strategies.
Abstract:
To assess the changes in the management of splenic trauma, the charts of all patients with splenic injury, documented either roentgenographically or at operation, treated at the Childrens Hospital of Los Angeles from 1965 through 1985 were reviewed. One hundred and eleven patients with confirmed splenic injury were treated. Forty-one patients were seen during the first decade (1965 to 1975) and 70 during the second decade (1976 to 1985). The majority of patients were boys with a mean age of seven years. All of the patients sustained blunt abdominal trauma. During the first decade, all of the patients who had a recognized splenic injury underwent splenectomy. In the second decade, 44 patients were treated without surgical intervention. Twenty-six of the patients required surgical treatment. Splenorrhaphy was successful in 15; however, splenectomy was required in 11 patients. The patients who required surgical therapy had more complications and required more blood products than those patients who were treated nonsurgically. The overall survival rate was 95 per cent and was similar in both decades. Associated injuries, not the splenic injury, were responsible for the lethal outcome of the nonsurvivors. Although the majority of children with splenic injury can be managed nonoperatively, surgical intervention continues to be necessary in our experience in approximately 38 per cent of the patients with an over-all splenic salvage rate of 85 per cent.