Management of pediatric trauma: Non-operative approach for grade V splenic injuries

In pediatric patients with grade V blunt splenic injuries, the optimal management strategy remains controversial, but more studies are supporting the non-operative management of these injuries. This study aims to elucidate the differences in clinical outcomes between operative intervention and non-operative management.

We reviewed 5 years of TQIP (2017-2021) data for pediatric patients (age< 18 years) with isolated grade V blunt splenic injuries. Patients with death on arrival, withdrawal of care, and transfers were excluded. We compared mortality and hospital complications between patients undergoing operative management (OM) and non-operative management (NOM).

The total study population consisted of 527 patients. 183 patients (34.7 %) underwent OM. There were no significant differences between the two groups in terms of mortality (0.5 % in OM and 0 in NOM, p = 0.347). Patients in the OM group had higher rates of unplanned intubation (1.6 % vs. 0, p = 0.041). OM group had significantly higher volume of blood transfusion within the first 24 h compared to NOM (202.29 ± 49.69 ml vs. 19.44 ± 50.46 ml, p < 0.001) and had longer hospital (6.03 ± 3.47 vs. 4.46 ± 2.52 days, p < 0.001) and ICU (3.33 ± 2.65 vs. 2.85 ± 1.64 days, p = 0.026) length of stay (LOS). Rates of home discharge was significantly different in both groups (98.6 % in NOM and 89.6 % in OM) and 6.5 % of OM group were discharged to short-term general hospitals or in-patient rehabilitation centers (p < 0.001).

We found fewer complications and hospital LOS and higher rates of routine home discharge in NOM of isolated grade V blunt splenic injuries in pediatric patients.

Level III retrospective study.