Management of pediatric splenic trauma

In this study, we aimed to present the management and treatment processes of patients with splenic trauma, discuss nonoperative treatment approaches, and share our institutional experience.

A total of 244 patients hospitalized for splenic trauma between January 2010 and January 2020 were retrospectively analyzed.

Splenic injury was present in 22% of trauma patients who presented to the emergency department and were consulted by pediatric surgery. The most common cause of splenic injury was falls (60%). Forty-three percent of patients were of school age. Ninety percent of patients had Grade I-III splenic injuries. The mean age at presentation was 7.90 years. The mean hematocrit level was 32% and the mean hemoglobin level was 10.90. Blood transfusion was administered to 29% of patients. Additional injuries were present in 45.9% of cases, with the lung being the most frequently affected organ. The mean length of hospital stay was 6.03 days. Mortality occurred in five patients, and morbidity was observed in five patients. There was a statistically significant correlation between blood pressure, urine output, and mortality. A statistically significant association was also found between platelet-to-lymphocyte ratio, blood transfusion, hemoglobin level, Glasgow Coma Scale (GCS) score, and mortality (p<0.001). Furthermore, significant correlations were identified between GCS score, length of hospital stay, neutrophil count, and the presence of additional injuries (p<0.001). A strong negative correlation was observed between lactate levels and blood transfusion (r=-0.610), as well as between lactate levels and GCS score (r=-0.645). In the ROC analysis evaluating lactate as a predictor of additional injury, a sensitivity of 58% and specificity of 83% were identified at a cutoff value of 1.9.

We recommend nonoperative management for patients with splenic injury, as it reduces mortality, morbidity, and healthcare costs. Treatment protocols for these patients should be scientifically standardized.