Related Experiment Video
Updated: Aug 14, 2026
Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions
Published on: December 20, 2024
An opportunity for continued improvement: Evaluating the use of angiography for pediatric blunt liver/spleen injuries
Nada Fadl1, Rosa B Choi1, Lindsay Master2
1Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, United States.
Insights
Angiography use in pediatric blunt abdominal trauma varies by trauma center type, despite guidelines. Overutilization may occur, indicating a need for standardized care in managing liver and spleen injuries.
Area of Science:
- Pediatric Trauma Surgery
- Interventional Radiology
- Abdominal Trauma Management
Background:
- Pediatric blunt abdominal trauma with hepatic/splenic injuries requires careful management.
- The 2019 APSA guidelines aim to standardize care for these injuries.
- Angiography is a key diagnostic and therapeutic tool.
Purpose of the Study:
- To evaluate current angiography utilization in pediatric blunt abdominal trauma with hepatic/splenic injuries.
- To assess adherence to the 2019 APSA guidelines.
- To identify factors influencing angioembolization and splenectomy rates.
Main Methods:
- Analysis of the Trauma Quality Improvement Program (2020-2023) for pediatric patients.
- Inclusion criteria: blunt abdominal trauma, hepatic/splenic injury.
- Exclusion criteria: penetrating trauma, in-hospital mortality at ER.
- Multivariable logistic regression to identify predictors of angioembolization/splenectomy.
- Trauma center categorization: adult, dual, pediatric.
Main Results:
- 13,788 pediatric patients analyzed; 97% managed without IR procedures.
- Angiography/angioembolization used in 1.6%/1.5% of patients, respectively.
- Patients undergoing IR had higher injury severity (ISS 29-35 vs. 17).
- Angioembolization associated with higher transfusion rates (85% vs. 18%).
- Angioembolization utilization varied by trauma center type (p < 0.001).
- Angioembolization did not independently reduce splenectomy odds.
Conclusions:
- Angiography and angioembolization use varies significantly across trauma center types, despite 2019 APSA guidelines.
- While more common in severe injuries, some patients undergo angiography without transfusion, suggesting potential overutilization.
- Opportunities exist to further standardize care based on established guidelines.
Purpose:
To evaluate the use of angiography in pediatric blunt abdominal trauma with hepatic and/or splenic injuries following the 2019 Updated APSA Blunt Liver/Spleen Injury Guidelines.
Methods:
The Trauma Quality Improvement Program (2020-2023) was queried for patients ≤18-years-old who sustained blunt abdominal trauma resulting in hepatic and/or splenic injury. Patient demographics, injury characteristics, interventions, and outcomes were analyzed. Trauma centers were categorized as adult, dual adult-pediatric, or pediatric trauma centers. Multivariable logistic regression was used to identify predictors of angioembolization and splenectomy. Patients with concomitant penetrating trauma and patients who died in the emergency room were excluded.
Results:
A total of 13,788 pediatric patients were identified. Most (13,363; 97%) were managed without interventional radiology procedures, while 217 (1.6%) underwent diagnostic angiography only and 208 (1.5%) underwent angioembolization. Patients undergoing angiography or angioembolization had greater injury severity compared with those managed without interventional radiology (median ISS 29 and 35 vs 17, p < 0.001). Markers of hemorrhage were more common among patients undergoing angioembolization, including transfusion requirement (85% vs 18%, p < 0.001). Notably, only 47% of patients undergoing angiography without embolization required transfusion. Angioembolization utilization differed by trauma center type (2.0% adult, 1.7% dual, 0.8% pediatric; p < 0.001). In addition, angioembolization was not independently associated with decreased odds of splenectomy.
Conclusions:
Despite the updated 2019 APSA guidelines, angiography and angioembolization utilization continue to vary across trauma center types. While interventional radiology remains more common in patients with markers of severe injury, a subset of patients underwent angiography without transfusion requirement, suggesting potential continued overutilization and opportunities to further standardize guideline-based care.