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Selective nonoperative management of pediatric blunt splenic trauma: risk for missed associated injuries
1Department of Pediatric Surgery, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Insights
Nonoperative management is safe and effective for children with blunt splenic trauma. This approach avoids unnecessary surgery and does not increase the risk of missed injuries in pediatric patients.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injuries
Background:
- The spleen is the most frequently injured organ in pediatric blunt abdominal trauma.
- Nonoperative management of blunt splenic trauma is standard in children but debated in adults.
- A key concern regarding nonoperative management is the potential for missed associated injuries.
Purpose of the Study:
- To evaluate the safety and efficacy of nonoperative management for blunt splenic injuries in children.
- To determine if nonoperative management increases the risk of overlooking associated injuries in pediatric patients.
Main Methods:
- Retrospective review of 120 pediatric patients with traumatic splenic injuries admitted between 1982 and 1990.
- Splenic injuries diagnosed via computed tomography scans, liver/spleen scintigraphy, or laparotomy.
- Analysis of management strategies (operative vs. nonoperative) and outcomes, including associated injuries.
Main Results:
- 112 patients (93.3%) were initially managed nonoperatively, with failure in only 2 patients (1.8%) requiring late splenectomy.
- 8 patients (6.7%) required emergency surgery; outcomes varied, including splenectomy, splenorrhaphy, or no repair.
- 59 patients had associated injuries (22 intra-abdominal); no missed injuries were identified, and no morbidity or mortality resulted from delayed treatment.
Conclusions:
- The majority of children with blunt splenic injury can be successfully treated nonoperatively.
- Selective nonoperative management of splenic injuries in children is safe and does not elevate the risk of missed associated injuries.
- Nonoperative management is a viable and effective strategy for pediatric blunt splenic trauma.
Abstract:
The spleen is the most commonly injured organ in children sustaining blunt abdominal trauma. Although accepted in pediatric patients, nonoperative management of blunt splenic trauma in adults remains controversial. A principal concern of advocates of early operation is the possibility of overlooking a second injury. To evaluate this question in a pediatric population, we reviewed the charts of 120 children who had traumatic splenic injuries and were admitted to Children's Hospital Medical Center in Cincinnati between 1982 and 1990. Splenic injuries were documented by computed tomography scans, liver/spleen scintigraphy, or during laparotomy. One hundred twelve patients (93.3%) were initially managed nonoperatively; this regimen failed in 2 patients (1.8%), in whom a late splenectomy was required for bleeding. Of 8 patients (6.7%) for whom emergency surgery was required, 4 underwent splenectomy (2 had major associated injuries), 2 underwent splenorrhaphy, and 2 required no splenic repair. Fifty-nine patients (49.2%) had associated injuries, 22 of which (18.3%) were intraabdominal. In this study, there were no missed injuries and no morbidity or mortality associated with delayed treatment. These data confirm that the majority of children with blunt splenic injury can be successfully treated without surgery, and demonstrate that selective nonoperative management of splenic injuries in children does not increase the risk of missed associated injuries.