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Blood transfusion requirements in children with blunt spleen and liver injuries
1Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey.
Insights
Surgical management of blunt spleen and liver injuries in children requires significantly more blood transfusions and longer hospital stays compared to conservative approaches. Conservative management is a safe and effective option for these pediatric patients.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injuries
Background:
- Blunt spleen and liver injuries are common in pediatric trauma.
- Treatment strategies range from conservative (non-operative) to surgical interventions.
- Understanding transfusion needs is crucial for optimizing patient care.
Purpose of the Study:
- To compare blood transfusion requirements between surgically and conservatively managed pediatric patients with blunt spleen and liver injuries.
- To analyze the impact of management strategy on hospital stay and outcomes.
Main Methods:
- Retrospective analysis of 174 children with blunt spleen and/or liver injuries over 16 years.
- Comparison of hematocrit (Hct) values, transfused blood volumes (ml/kg), and length of hospital stay between non-operative and operative groups.
- Inclusion of patients with isolated and combined spleen/liver injuries.
Main Results:
- Initial Hct values were similar between groups (26.7% vs. 24.8%).
- Surgically treated patients received significantly higher blood volumes (39.5 ml/kg vs. 20.9 ml/kg, p < 0.05).
- Surgical management was associated with a longer mean hospital stay.
Conclusions:
- Conservative management of blunt spleen and liver injuries in children is safe and associated with lower transfusion requirements.
- Surgical intervention may lead to increased bleeding and higher transfusion needs.
- Operative management should be reserved for highly selected cases; observation is often sufficient.
Abstract:
The records of 174 children sustaining blunt spleen and liver injuries in a 16-year period were analyzed retrospectively to determine blood transfusion requirements in surgically versus conservatively managed patients. The whole study group consisted of 97 spleen, 70 liver, and 7 combined spleen and liver injuries respectively. Seventy-eight patients were managed conservatively while 96 children had undergone various operative procedures. The hematocrit (Hct) values, transfused blood volumes (ml/kg), and length of hospital stay were compared between the non-operative and operative treatment groups. Although the initial Hct values were found to be similar in non-operative versus operative groups (26.7% +/- 2.7% vs. 24.8% +/- 3.5%), transfused blood volumes were significantly higher in the surgically treated group respectively (20.9 ml/kg vs. 39.5 ml/kg) (p < 0.05). Similarly, mean length of hospital stay was longer in the surgical groups. Associated injuries were seen in 105 (60.3%) patients distributed randomly among two study groups. Twelve patients in the series died of other system/organ involvement. There were no deaths in isolated spleen and/or liver injuries. Increased blood transfusion requirement in surgical groups may be due to excessive bleeding prior to the operation which virtually provides the indication for laparotomy. Manipulation and suturing enhances additional bleeding to elevate the total volume to be delivered. Operative choice should be spared for very selected cases, and conservative management is safe; procedures such as splenorrhaphy are not superior to observation therapy as a means of controlling intraabdominal bleeding.