Management of pediatric splenic trauma

Area of Science:

• Pediatric Surgery
• Trauma Management
• Surgical Outcomes

Background:

• Splenic trauma is a significant concern in pediatric patients.
• Understanding management and treatment is vital for improving outcomes.

Purpose of the Study:

• To present the management and treatment of pediatric splenic trauma.
• To discuss nonoperative treatment approaches.
• To share institutional experience in managing splenic injuries.

Main Methods:

• Retrospective analysis of 244 patients hospitalized for splenic trauma.
• Study period: January 2010 to January 2020.
• Inclusion criteria: Patients with splenic trauma.

Main Results:

• Splenic injury occurred in 22% of trauma patients seen by pediatric surgery.
• Falls were the most common cause (60%), with 43% of patients school-aged.
• 90% had Grade I-III injuries; mean age 7.9 years.
• Blood transfusion in 29%; 45.9% had additional injuries (lung most common).
• Mortality in 5 patients, morbidity in 5.
• Significant correlations found between blood pressure, urine output, platelet-to-lymphocyte ratio, hemoglobin, GCS score, lactate levels, and mortality.
• Lactate levels predicted additional injury with 58% sensitivity and 83% specificity at a cutoff of 1.9.

Conclusions:

• Nonoperative management is recommended for splenic injury to reduce mortality, morbidity, and healthcare costs.
• Standardizing treatment protocols for pediatric splenic trauma is essential.
• Evidence supports nonoperative approaches for select splenic injuries.