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Published on: December 20, 2024
Embolization for pediatric blunt splenic injury is an alternative to splenectomy when observation fails
Jessica L Gross1, Nicole L Woll, Carol A Hanson
1From the Departments of Surgery (J.L.G., N.L.W., C.A.H., R.J.S., A.P.K., C.P.C.), and Radiology (C.P.), Geisinger Medical Center, Danville, Pennsylvania.
Insights
Splenic artery embolization is a safe option for pediatric blunt splenic trauma, offering an alternative to splenectomy when observation fails. This approach shows a higher transfusion rate but improves splenic salvage rates in children.
Area of Science:
- Pediatric Trauma Surgery
- Interventional Radiology
- Surgical Outcomes
Background:
- Nonoperative management is preferred for splenic injuries in children and adults, offering benefits like shorter hospital stays and reduced mortality.
- Angiography with embolization has increased splenic salvage in adults, but pediatric data are limited.
- Conserving the spleen avoids infectious complications and reduces overall morbidity.
Purpose of the Study:
- To evaluate the efficacy and outcomes of splenic artery embolization in pediatric patients with blunt splenic trauma.
- To compare observation, embolization, and splenectomy as initial treatments for blunt splenic injury in children.
- To assess the rates of splenic salvage, blood transfusion, and mortality across different treatment groups.
Main Methods:
- A retrospective study analyzed data from 1999-2009 for children (≤18 years) with blunt splenic injury.
- Patients were categorized by initial treatment: observation, embolization, or splenectomy.
- Outcomes analyzed included treatment success, need for blood transfusion, splenic salvage, and mortality.
Main Results:
- Of 259 children, 227 were observed, 15 underwent embolization, and 17 had splenectomy.
- Splenic salvage rates were 92% overall. Observation failed in 4%, embolization in 7%, and splenectomy was definitive for 17 patients.
- The embolization group had a higher transfusion rate (40%) than observation (17%) but no deaths, unlike the observation (3 deaths) and splenectomy (4 deaths) groups.
Conclusions:
- Splenic artery embolization is a viable intermediate option for pediatric blunt splenic trauma when observation is insufficient.
- While associated with increased transfusion requirements, embolization provides a safe alternative to splenectomy, enhancing splenic preservation.
- Further research is needed to optimize embolization protocols and fully elucidate its long-term benefits in pediatric patients.
Background:
Management of splenic injury has shifted from operative to nonoperative management in both children and adults with reports of high success rates. Benefits of splenic conservation include decreased hospital stay, blood transfusion, and mortality, as well as avoidance of infectious complications. Angiography with embolization is an innovative adjunct to nonoperative management and has resulted in increased splenic salvage in adults; however, data in the pediatric population are scant.
Methods:
A retrospective comparative study of a single-hospital trauma registry reviewed from 1999 to 2009. Patients 18 years and younger admitted with injury to the spleen were included. Children with penetrating injury were excluded. Children were divided into three categories by initial treatment: observation, embolization, or splenectomy. Data recorded include age, radiographic grade of injury, and Injury Severity Score (ISS). Groups were analyzed for success of initial treatment, requirement for transfusion of packed red blood cells, splenic salvage, and mortality.
Results:
Registry review identified 259 children with blunt splenic injury. Initial treatment was observation in 227, embolization in 15, and splenectomy in 17. In the observation group, 9 (4%) of 227 children failed initial treatment; 8 of these underwent embolization, while 1 unerwent splenectomy. In the embolization group, 1 (7%) of 15 failed initial treatment and underwent splenectomy. Blood transfusion was required by 38 (17%) of 227 in the observation group, 6 (40%) of 15 (p = 0.02) in the embolization group, and 15 (88%) of 17 (p < 0.01) in the splenectomy group. Overall splenic salvage rate was 237 (92%) of 259. Three children died in the observation group, and four children died in the splenectomy group. There was no death in the embolization group.
Conclusion:
Splenic artery embolization for blunt trauma in children is associated with a higher blood transfusion rate compared with observation but offers a safe, intermediate alternative to splenectomy when observation fails.
Level Of Evidence:
Therapeutic study, level IV.
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