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Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population
Kristy L Rialon1, Brian R Englum1, Brian C Gulack1
1Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Insights
Splenic angioembolization (SAE) in children with high-grade splenic trauma shows similar outcomes to splenectomy. This minimally invasive approach offers comparable safety and effectiveness for pediatric splenic injuries.
Area of Science:
- Pediatric Trauma Surgery
- Interventional Radiology
- Emergency Medicine
Background:
- Splenic angioembolization (SAE) is gaining traction for adult splenic injuries, but its efficacy in pediatric cases remains uncertain.
- Evaluating SAE versus splenectomy is crucial for optimizing pediatric trauma care.
Purpose of the Study:
- To compare the outcomes of splenectomy and SAE in pediatric patients with splenic trauma.
- To assess the safety and effectiveness of SAE in managing high-grade splenic injuries in children.
Main Methods:
- Utilized the National Trauma Data Bank (2007-2011) for pediatric patients (0-15 years) with splenic trauma.
- Conducted a propensity analysis and inverse probability weighting for subgroup analysis of high-grade injuries comparing splenectomy and SAE.
Main Results:
- Over 90% of 11,694 pediatric splenic trauma cases were managed nonoperatively.
- In high-grade injuries, 265 children had splenectomy and 199 underwent SAE; no significant differences in Injury Severity Score, transfusions, or complications.
- Adjusted mortality was 13.4% for splenectomy and 10.0% for SAE (P = .31).
Conclusions:
- Splenic angioembolization (SAE) is a viable alternative to splenectomy for high-grade pediatric splenic trauma.
- SAE demonstrates comparable morbidity and mortality rates to splenectomy in this pediatric cohort.
Background:
Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE.
Methods:
The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting.
Results:
Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) CONCLUSION: Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy.
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