Related Experiment Videos
Splenic injury in children: a 10 year experience
R K Choong1, T M Grattan-Smith, R C Cohen
1Division of Paediatrics, Westmead Hospital, New South Wales, Australia.
Insights
Non-operative management is safe for hemodynamically stable pediatric patients with splenic trauma. This approach, prioritizing careful assessment and observation, is preferred over surgery for splenic injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Trauma
Background:
- Splenic trauma is a significant concern in pediatric blunt injuries.
- Effective management strategies are crucial for patient outcomes.
Purpose of the Study:
- To retrospectively review the management of splenic trauma in children.
- To evaluate the safety and efficacy of non-operative versus operative approaches.
Main Methods:
- Retrospective review of 49 pediatric patients with blunt splenic trauma.
- Analysis of injury causes, severity (Injury Severity Score), investigations, and management strategies.
- Data collected over a 10-year period at a tertiary referral center.
Main Results:
- Road trauma was the primary cause (73%).
- Non-operative management was successful in 57% of cases.
- Exploratory laparotomy, splenic salvage, and splenectomy were performed in 10%, 4%, and 26% of patients, respectively.
- All nine deaths were associated with severe road trauma (mean ISS = 59).
Conclusions:
- Non-operative management is a safe and preferred treatment for hemodynamically stable children with splenic injuries.
- Meticulous observation and experienced assessment are vital for successful non-operative care.
- Laparotomy is indicated for persistent hemodynamic instability; splenectomy reserved for uncontrolled hemorrhage.
Abstract:
The aim of this report was to review retrospectively the management of splenic trauma at a major Australian tertiary referral centre (Westmead Hospital) over a 10 year period. Forty-nine patients (0-15 years of age) with documented blunt splenic trauma were identified. The causes of splenic injury were road trauma (73%) and falls (27%). There were 22 minor injuries (Injury severity score [ISS] < 16) and 27 severe injuries (ISS > or = 16). All nine deaths were related to road trauma (mean ISS = 59). The investigation most commonly used was CT scanning (47%). Peritoneal lavage was performed in six patients (12%). Management involved non-operative care in 29 patients (57%), exploratory laparotomy alone in 5 (10%), splenic salvage in 2 (4%) and splenectomy in 13 (26%). This experience supports the view that non-operative management of splenic injury in haemodynamically stable children is safe and is the preferred treatment. Experienced assessment and meticulous observation is necessary. Laparotomy is indicated if there is continuing haemodynamic instability despite resuscitation. Operative management is aimed at splenic salvage with splenectomy being reserved for uncontrolled haemorrhage.