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Non-Trauma Centre Management of Pediatric Blunt Abdominal Trauma with Spleen and Liver Injuries: Does One Size Fit All? - Abstract

Alison M Campbell, Ramnik V Patel, Rejoo D Daniel, Mahmud Fleet, Sanja Besarovic

 

Abstract

Introduction: The abdomen is the most common site of initially unrecognised fatal injury in blunt pediatric trauma. Commonly the spleen and liver are involved. Management is usually conservative. American Pediatric Surgical Association (APSA) guidelines for isolated spleen and liver injury have been validated in large trauma centres. We aimed to review our experience of managing pediatric blunt spleen and liver injury and compare this with APSA guidelines.

Patients and Methods: We retrospectively reviewed all pediatric blunt trauma patients (Grade 2 to Grade 5 spleen or liver injury on imaging) presenting to our department between 2000 and 2011.

Results: Twenty-nice patients (8 girls) with blunt abdominal trauma (spleen 22, liver 6, both 1) were managed conservatively (22) or surgically (7). Three patients died (18 to 72 hours post injury); all had multisystem trauma and underwent surgery. All isolated injuries were successfully managed conservatively (1 embolization). Median hospital stay was 9 days and median bed rest 11 days. Pre-discharge imaging was performed in 20 and post discharge imaging in 13. Failure of conservative management occurred within 72 hours of admission and only with associated injuries.

Conclusion: While our outcomes do not differ from major centres, our follow up is more cautious with increased use of ultrasound and increased length of hospital stay. Non-operative management was successful in all isolated injuries. We further demonstrate that embolization is a useful adjunct in splenic preservation and worth considering.

Keywords: abdomen, blunt trauma, child, embolization, interventional radiology, liver, spleen, ultrasonography, tomography, radiograph, computed axial tomogram (CAT)

 

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