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Isolated high-grade splenic injury among pediatric patients in Japan: Nationwide descriptive study
Makoto Aoki1, Toshikazu Abe2, Shuichi Hagiwara3
1Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Insights
Pediatric patients with isolated high-grade splenic injury in Japan show high survival and splenic salvage rates. Splenic artery embolization (SAE) was frequently used in management, differing from prior studies.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Emergency Medicine
Background:
- Limited data exists on pediatric isolated splenic injuries in Japan.
- Understanding clinical characteristics, management, and outcomes is crucial for this patient group.
Purpose of the Study:
- To evaluate the characteristics, management, and outcomes of pediatric patients with isolated splenic injury in Japan.
- Specifically focusing on survival and splenic salvage rates.
Main Methods:
- Multicenter retrospective cohort study using the Japan Trauma Data Bank (2004-2018).
- Pediatric patients with isolated high-grade splenic injury (Abbreviated Injury Scale ≥3) were analyzed.
- Management groups included nonoperative management (NOM), NOM with splenic artery embolization (SAE), and operative management (OM).
Main Results:
- 230 pediatric patients with isolated high-grade splenic injury were identified.
- Most patients (68%) were managed nonoperatively (NOM), 27% with NOM + SAE, and 5.2% with operative management (OM).
- A 97% splenic salvage rate and 100% survival rate were observed, with no in-hospital deaths.
Conclusions:
- Pediatric patients with isolated high-grade splenic injury in Japan exhibit high survival and splenic salvage rates.
- Splenic artery embolization (SAE) was utilized more frequently than reported in previous studies.
Background:
Limited information exists regarding the clinical characteristics, management practice, and outcomes of pediatric patients with isolated splenic injury in Japan. This study aimed to evaluate the characteristics, management, and outcomes, such as survival and splenic salvage rate of pediatric patients with isolated splenic injury in Japan.
Method:
This study was a multicenter retrospective cohort study using patient data from the Japan Trauma Data Bank (JTDB) collected between 2004 and 2018. Pediatric patients with isolated high-grade splenic injury whose abbreviated injury scale≥3 were classified according to management groups: nonoperative management (NOM); NOM with splenic artery embolization (SAE); and operative management (OM). The primary outcome was in-hospital survival and the secondary outcomes were splenic salvage rate, hospital length of stay (LOS), rate of discharging to home, and complications.
Results:
There were 230 pediatric patients with isolated high-grade splenic injury during the study period. Of these, 156 (68%) were managed by NOM, 62 (27%) were managed by NOM with SAE, and 12 (5.2%) were managed by OM. No pediatric patient with isolated high-grade splenic injury died between 2004 and 2018 in Japan, and the splenic salvage rate was 97%.
Conclusion:
We identified a high survival rate and splenic salvage rate among pediatric patients with isolated high-grade splenic injury in Japan. SAE was often used, in contrast with previous reports.
Levels Of Evidence:
Level IV.
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