Angio-embolization in pediatric splenic trauma

The present study aims to assess contemporary changes in angioembolization frequency for pediatric splenic trauma patients, associated presenting factors, successful spleen salvage rate, and overall splenectomy incidence.

Splenic trauma patients aged 1-18 were identified in the 2021-2023 National Trauma Data Bank. Rates of splenic embolization, spleen salvage rate after embolization, and splenectomy were calculated for the overall pediatric population and age groups 1-3, 4-6, 7-12, and 13-18. Univariate binary logistic regressions were performed to elucidate associations between presenting characteristics and angioembolization, splenectomy, and failed angioembolization.

Of 11,987 pediatric splenic trauma patients, 10,631 (88.7%) were managed conservatively. 1140 received splenectomy directly. 216 (1.80%) underwent splenic embolization; 196 were successful while 20 required splenectomy, totaling 1160 (9.68%) undergoing splenectomy. Notably, 90.74% of angioembolizations successfully salvaged spleens. Embolization rate increased each year while splenectomy rate decreased each year from 2021 to 2023, and both modalities were most prevalent amongst teenagers (2.37% and 12.68%, respectively). Increasing injury severity score, age, cc of whole blood administered in the first 4 h, and decreased presenting systolic blood pressure were all associated with increased likelihood of both angioembolization and splenectomy. Male sex was associated with splenectomy only. Only injury severity score and age were associated with failed angioembolization. Race and ethnicity were not associated with any treatment modality nor outcome.

Splenic embolization in the pediatric trauma population has remained a relatively rare but efficacious treatment most frequently utilized for older, less hemodynamically stable patients.