Risk factors associated with splenectomy following a blunt splenic injury in pediatric patients

Area of Science:

• Pediatric Surgery
• Trauma Care
• Surgical Outcomes

Background:

• Splenectomy is a significant intervention in pediatric trauma.
• Identifying factors influencing splenectomy is crucial for optimizing patient management.
• Previous studies have explored various risk factors, but specific associations in pediatric blunt splenic trauma require further elucidation.

Purpose of the Study:

• To identify factors associated with splenectomy in pediatric trauma patients.
• To determine the predictors of splenectomy in children sustaining blunt splenic injuries.
• To inform clinical decision-making regarding spleen preservation versus removal.

Main Methods:

• Utilized the Pediatric Trauma quality improvement program (P-TQIP) database (2014-2016).
• Included pediatric patients (age ≤ 18 years) with blunt splenic injury.
• Performed univariate and multivariate logistic regression analyses to identify risk factors for splenectomy.

Main Results:

• Of 1297 patients, 57 (4.4%) underwent total splenectomy.
• Multivariate analysis identified blood transfusion within 4 hours and severity of splenic injury as significant predictors.
• The model demonstrated strong predictive accuracy with an AUC of 0.892.

Conclusions:

• Early blood transfusion (within 4 hours) and high-grade splenic injury are primary factors associated with splenectomy in pediatric trauma.
• These findings highlight the importance of injury severity assessment and timely resuscitation in managing pediatric splenic trauma.
• The study underscores the need for careful consideration of splenectomy in pediatric patients with severe splenic injuries requiring rapid transfusion.