Does the spleen fully recover? Immune function after non-operative management of splenic injury

Blunt splenic trauma in children is increasingly managed non-operatively (NOM), given the spleen's critical role in immune function and the high success rate of NOM. While the immunodeficiency following splenectomy is well-established, the long-term immune outcomes after NOM for high-grade splenic injuries remain underexplored in pediatric patients.

A matched-pair case-control study was conducted, including children under 18 treated with NOM for AAST grade III-V blunt splenic injuries between 2013 and 2023, and age-, sex-, and year-matched controls with acute appendicitis. Data on demographics, medical history, infection-related outcomes, and healthcare utilization were collected from medical records, national health databases, and caregiver questionnaires.

Sixty children with high-grade splenic injuries were matched with 60 controls. Over a mean follow-up of 5.4 years, infection rates, including pneumonia and otitis media, were comparable between groups. No cases of overwhelming post-splenectomy sepsis or positive blood cultures were reported. Antibiotic use was similar (31% in the NOM group vs. 24% in controls, p=0.52).

Non-operative management of high-grade blunt splenic injuries in children is associated with infection rates comparable to healthy controls, suggesting that splenic immune function may not be significantly compromised. These findings suggest there is no need for vaccination and prophylactic antibiotic treatment in this population. Further research incorporating laboratory assessments is warranted to validate and refine long-term management strategies.