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Changes in the management of pediatric blunt splenic and hepatic injuries
1Department of Pediatric Surgery, Central Emek Hospital, and the Faculty of Medicine, Technion Institute of Technology, Afula, Israel.
Insights
Hemodynamically stable children with isolated spleen or liver injuries do not require intensive care monitoring. Blood transfusions are only needed for those with low hematocrit and ongoing bleeding.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injuries
Background:
- Nonoperative management of splenic and hepatic injuries is standard in pediatric trauma.
- Current practice includes intensive care monitoring and blood replacement for stable patients.
- This approach has a reported 90% success rate in children's trauma centers.
Purpose of the Study:
- To evaluate the necessity of intensive care monitoring for hemodynamically stable pediatric patients with isolated splenic or hepatic injuries.
- To refine criteria for blood replacement in these patients.
- To assess the feasibility of early mobilization in pediatric liver and spleen trauma.
Main Methods:
- Retrospective review of 55 children under 14 years with splenic or hepatic injuries diagnosed by computed tomography over 5 years.
- Analysis of injury patterns (isolated vs. associated injuries) and treatment protocols.
- Detailed monitoring of hemodynamic stability, blood transfusion requirements, and outcomes.
Main Results:
- Of 55 children, 38% had isolated injuries (18 spleen, 2 liver, 1 combined).
- Only one patient with spleen laceration required surgery due to instability.
- 20 patients with isolated injuries were monitored in ICU; 4 received blood transfusions despite being stable.
- No morbidity or mortality was observed in any of the 55 children.
Conclusions:
- Intensive care monitoring is not essential for hemodynamically stable pediatric patients with isolated liver or spleen injuries.
- Blood replacement should be reserved for patients with hematocrit <20% and signs of persistent bleeding.
- Early progressive mobilization may be suitable for pediatric patients with these injuries, considering organ characteristics.
Background/Purpose:
Intensive care monitoring, blood replacement, and nonoperative treatment of splenic and hepatic injuries in stable patients is the standard practice in pediatric surgery with a success rate of 90% in children's trauma centers.
Methods:
During the past 5 years, 55 children under 14 years of age have been treated for laceration of spleen, liver, or both, proven by computed tomography.
Results:
In 34 (62%), other injuries were identified, and only 21 (38%) presented with isolated injuries. In the 21 children who had isolated injuries, 18 had laceration of spleen, two had liver lacerations, and one had liver and spleen laceration. One patient who had spleen laceration required laparotomy and splenorrhaphy because of hemodynamic instability 4 hours after admission. The other 20 patients were initially closely monitored indiscriminately in the Intensive Care Unit of the pediatric surgical nursing unit. Blood transfusion was given to four children during the first 24 hours of admission despite the fact that, retrospectively, all were hemodynamically stable. There was no morbidity or mortality in all the 55 children.
Conclusions:
The results of this study suggest that intensive care monitoring is not mandatory in hemodynamically stable patients who have isolated liver or spleen injuries. Blood replacement should be indicated in patients who have hematocrit levels lower than 20% and signs of continuing blood loss. Because of structural characteristics of the young liver and spleen, early progressive mobilization can be indicated.