New opinion on radiological grade and conservative treatment of children splenic injury

Abstract

Objective Radiological grade of splenic injury was seldomly used in China trauma center now, though it had been established in 1994 by American Association for Surgery of Trauma (AAST) and widely used.The present study is aimed to analyze the imaging grade and clinical characteristics of traumatic splenic rupture in children, discuss the feasibility of conservative treatment, and the role of radiographic grading during clinical treatment. Methods Information (including age, gender, severity based on radiological findings, treatment strategies, and clinical outcome) regarding 59 hospitalized splenic injury patients whose injuries occurred between 2008 and 2014 was retrospectively analyzed. Results Between 2008 and 2014, 59 pediatric patients with splenic injury were treated in our institution.Median age was 9.5 years (range, 3 months to 16 years). Of all patients, 41 (69.5%) were male.The injuries were primarily caused by traffic crash (45.7%), stumbling/falling from a height (38.9%). According to AAST, 5 cases were grade Ⅰ, 26 patients grade Ⅱ (44.1%), and 21 cases grade Ⅲ (35.6%), 6 over grade Ⅳ, and only one was unclear.Of all patients, 25 cases were with the other organs complications.All patients underwent fasting, bed rest, and antibiotics.Only 1 case was transferred to operation during the conservative treatment.Forty-nine patients underwent with CT scan over 2 times. Conclusion Imaging classification helps guide clinical treatment.Conservative treatment is feasible for traumatic splenic injury in children.Early imaging classification of splenic injury may be helpful in clinical judgment, and reduce children radiation exposure. Key words: Children; Splenic injury; Conservative therapy; Radiation exposure,