A Standardized Approach for Spleen Trauma in the Children

Abstract

Aim: The aim of this study is to evaluate the results of pediatric blunt spleen trauma patients who were treated with a standard fluid protocol. Patients and Method: Children who were treated in a university hospital for blunt spleen trauma between 2012 and 2015 were included. Age, gender, mechanism of the injury, spleen injury scale, concomitant injuries, hemoglobin levels, thrombocytopenia and thrombocytosis, administration of blood and blood products, and hospital stay duration and results were evaluated. The fluid requirements of the stable children were calculated according to Holliday-Segar equation. The fluid intake of the children was adjusted so that the urine output was 1 ml/kg/h. Results: Totally 28 children who were at the age of 3-18 years were evaluated. Injury grade(G) was G1 in 3 patients, G2 in 12 patients, G3 in 10 patients, G4 in 2 patients, and G5 in 1 patient. There were no side effects related to the fluid protocol and the monitoring of the urinary output was helpful. Grade 5 patient needed an immediate splenectomy. Thrombocytosis was developed in four patients during the hospitalization and it suggested an impaired clearance of spleen in Grade 4 patients. Re-bleeding developed in one G3 patient after discharge. No mortality was observed. Conclusion: Our management protocol was successfully applied and spleen loss was observed only in a case of grade 5 injury. Adjusting the fluid volume according to the urinary output prevented volume overload and re-bleeding. Thrombocytosis may occur after severe splenic trauma and it should be carefully followed up.