Long-Term Follow-Up of Children With Nonoperative Management of Blunt Splenic Trauma

Abstract

: The effectiveness of nonoperative management (NOM) of blunt splenic injuries (BSIs) in children is established; however, only limited data of their long-term follow-up exist. We hypothesize that long-term follow-up verifies that NOM of BSI in children is safe and effective. : From 1993 to 2008, 153 children (1-17 years, mean = 12) with BSI were admitted. Patients were contacted by telephone and answered a standardized questionnaire. Medical records were reviewed to validate injury grade, hospital stay, and complications. : Eighty patients (52%) participated; 18 were excluded (8 splenectomies, 2 splenorraphies, 3 comatose, 2 language barriers, and 3 with unavailable records). Mean follow-up of the remaining 62 patients was 74 months (range, 5-165 months). There were 9 grade I, 9 grade II, 22 grade III, 20 grade IV, and 2 grade V injuries. Mechanism of injury was motor vehicle crashes (14), falls (11), all terrain vehicle (ATV) crashes (10), snow recreation related (14), and other recreation (13). Two patients were readmitted for spleen complications (splenic cyst and hematoma), but neither required additional treatment. Seven patients reported potential spleen-related complications: six immunologic (asthma, rashes, and increased illness), two abdominal pain, and two psychiatric related to fear of reinjuring their spleen. Three children sustained a second BSI, and none required surgical intervention. : Long-term follow-up indicates that our protocol for NOM of BSI in children is safe, including secondary injuries. However, this study indicates that children who sustain BSI may require more counseling than presently provided. With an intact spleen, fear of immunologic dysfunction is irrational and indicates a lack of understanding at discharge. In addition, more intensive investigation and interventions for families that may suffer from posttraumatic stress disorder or related disorders appears indicated.