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Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization

Samiksha Bansal1, Frederick M Karrer2, Kristine Hansen2

  • 1Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, St Louis, MO 63104, USA.

American Journal of Surgery
|April 2, 2015
PubMed

Insights

Pediatric blunt splenic trauma can be managed nonoperatively without splenic artery embolization (SAE), even with contrast blush (CB) on CT scans. Hemodynamic stability is key for safe, effective treatment in children.

Area of Science:

  • Pediatric Trauma Surgery
  • Interventional Radiology
  • Emergency Medicine

Background:

  • Current guidelines recommend splenic artery embolization (SAE) for blunt splenic trauma with contrast blush (CB) to improve nonoperative management success.
  • This study questions the necessity of SAE in pediatric blunt splenic injuries.

Purpose of the Study:

  • To evaluate the impact of contrast blush (CB) on computed tomography (CT) in pediatric patients with blunt splenic trauma managed nonoperatively.

Main Methods:

  • Retrospective review of pediatric patients (<18 years) with blunt splenic trauma over 10 years at a level 1 pediatric trauma center.
  • All patients were managed nonoperatively without SAE.
  • Comparison of outcomes between patients with and without CB on CT scans.

Main Results:

  • Of 270 pediatric patients with blunt splenic injury, 47 (17.4%) showed CB on CT.
  • No significant differences were observed in the need for blood transfusion, length of stay, or splenectomy rates between groups with and without CB.
  • All patients were successfully managed nonoperatively without SAE.

Conclusions:

  • Pediatric blunt splenic injuries can be safely managed nonoperatively without SAE, irrespective of CB presence on CT.
  • Physiologic response and hemodynamic stability are the primary factors guiding management decisions.
Abstract

Keywords:
Angiographic embolizationContrast blushPediatricSplenic trauma

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