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Updated APSA Guidelines for the Management of Blunt Liver and Spleen Injuries
Regan F Williams1, Harsh Grewal2, Ramin Jamshidi3
1Le Bonheur Children's Hospital, 49 North Dunlap Avenue, Second Floor, Memphis, Tn, 38105, USA.
Insights
Updated guidelines for non-operative management of blunt liver and spleen injuries in children are presented. These guidelines simplify care, focusing on clinical condition for discharge and reserving advanced interventions for actively bleeding patients.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injury
Background:
- Non-operative management of blunt liver and spleen injuries in children was first guided by the American Pediatric Surgical Association (APSA) in 2000.
- Subsequent research has expanded on initial guidelines, investigating new therapies to enhance patient care.
- Current consensus and literature reviews form the basis for updated management strategies.
Purpose of the Study:
- To present updated management guidelines for blunt liver and spleen injuries in pediatric patients.
- To provide an easy-to-implement strategy based on current evidence and expert consensus.
- To refine admission, procedural, discharge, and aftercare protocols for these injuries.
Main Methods:
- Utilized a recent literature review by the APSA Outcomes committee as the foundation for guideline recommendations.
- Assembled a task force from the APSA Committee on Trauma to review existing guidelines and literature.
- Developed an easily implementable guideline based on comprehensive review and consensus.
Main Results:
- Guidelines are structured into Admission, Procedures, Discharge, and Aftercare.
- Intensive care unit admission is based on vital signs post-resuscitation; stable patients are admitted to the ward.
- Transfusions are recommended for hemoglobin <7 mg/dL or active bleeding; angioembolization/surgery reserved for persistent bleeding.
- Discharge decisions are based on clinical condition, not injury grade; follow-up imaging is only for symptomatic patients.
Conclusions:
- The updated American Pediatric Surgical Association (APSA) guidelines offer a simplified management approach for children with blunt liver and spleen injuries.
- These guidelines aim to standardize and improve the care of pediatric patients with these specific trauma types.
Background:
Non-operative management of blunt liver and spleen injuries was championed initially in children with the first management guideline published in 2000 by the American Pediatric Surgical Association (APSA). Multiple articles have expanded on the original guidelines and additional therapy has been investigated to improve care for these patients. Based on a literature review and current consensus, the management guidelines for the treatment of blunt liver and spleen injuries are presented.
Methods:
A recent literature review by the APSA Outcomes committee [2] was utilized as the basis for the guideline recommendations. A task force was assembled from the APSA Committee on Trauma to review the original guidelines, the literature reported by the Outcomes Committee and then to develop an easy to implement guideline.
Results:
The updated guidelines for the management of blunt liver and spleen injuries are divided into 4 sections: Admission, Procedures, Set Free and Aftercare. Admission to the intensive care unit is based on abnormal vital signs after resuscitation with stable patients admitted to the ward with minimal restrictions. Procedure recommendations include transfusions for low hemoglobin (<7 mg/dL) or signs of ongoing bleeding. Angioembolization and operative exploration is limited to those patients with clinical signs of continued bleeding after resuscitation. Discharge is based on clinical condition and not grade of injury. Activity restrictions remain the same while follow-up imaging is only indicated for symptomatic patients.
Conclusion:
The updated APSA guidelines for the management of blunt liver and spleen injuries present an easy-to-follow management strategy for children.
Level Of Evidence:
Level 5.
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