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Nonoperative management of blunt hepatic and splenic injury in children
S J Bond1, M R Eichelberger, C S Gotschall
1Division of Pediatric Surgery, University of Louisville, School of Medicine, Louisville, Kentucky 40292, USA.
Insights
Nonoperative management of pediatric liver and spleen injuries is highly successful, with a 97.4% success rate. This approach, guided by physiology, minimizes complications and transfusion needs in pediatric trauma patients.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Surgical Outcomes
Background:
- Solid visceral injuries, specifically to the liver and spleen, pose significant risks in pediatric trauma.
- Nonoperative management is increasingly considered for pediatric blunt solid organ injuries.
Purpose of the Study:
- To assess the risks and success rates of nonoperative management for solid visceral injuries in children.
- To evaluate the safety and efficacy of nonoperative treatment for pediatric blunt hepatic and splenic trauma.
Main Methods:
- Retrospective analysis of pediatric patients (4 months-14 years) admitted to a level I pediatric trauma center over a 6-year period.
- Inclusion of patients with liver or spleen injuries, assessing outcomes of nonoperative versus operative management.
- Utilized diagnostic computed tomography (CT) and focused on physiologic parameters for management decisions.
Main Results:
- Out of 179 children with liver or spleen injuries, 97.4% were successfully managed nonoperatively.
- Delayed diagnosis of enteric perforations occurred in two children.
- Transfusion rates decreased significantly over the study period, especially in the latter half, despite increasing injury severity.
Conclusions:
- Pediatric blunt hepatic and splenic trauma carries substantial mortality risk.
- Nonoperative management, guided by physiologic parameters, is highly successful and safe for pediatric blunt liver and spleen injuries.
- This approach leads to few missed injuries and a low transfusion rate, making it a preferred strategy.
Objective:
The authors assessed the risks of nonoperative management of solid visceral injuries in children (age range, 4 months-14 years) who were consecutively admitted to a level I pediatric trauma center during a 6-year period ending in 1991.
Method:
One hundred seventy-nine children (5.0%) sustained injury to the liver or spleen. Nineteen children (11.2%) died. Of the 160 children who survived, 4 received emergency laparotomies; 156 underwent diagnostic computer tomography and were managed nonoperatively. The percentage of children who were successfully treated nonoperatively was 97.4%. Delayed diagnosis of enteric perforations occurred in two children. Fifty-three children (34.0%) received transfusions (mean volume 16.7 mL/kg); however, transfusion rates during the latter half of the study decreased from 50% to 19% in children with hepatic injuries, despite increasing grade of injury, and decreased from 57% to 23% in the splenic group with similar injury grade (p < 0.005, chi square test and Student's t test).
Conclusion:
Pediatric blunt hepatic and splenic trauma is associated with significant mortality. Nonoperative management based on physiologic parameters, rather than on computed tomography grading of organ injury, was highly successful, with few missed injuries and a low transfusion rate.
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