Pediatric Blunt Solid Organ Injury: Beyond the APSA Guidelines

Abstract

The APSA guidelines were published in 2000 making nonoperative management of pediatric blunt liver and spleen injury standard for most injured children. A review of recent literature supports significant changes in management of children with liver, spleen, as well as kidney injury. Of the >300 articles on pediatric abdominal injury since the publication of the APSA guidelines, no randomized controlled trials have been conducted. Six prospective studies, however, have been completed, and several large database studies add significant insights into our understanding of pediatric spleen, liver, and kidney injury. Significant decreases in use of resources can be safely applied to children with hemodynamic stability at presentation. Recent studies suggest management based on physiologic criteria rather than injury grade may result in improved resource utilization through shortened hospitalization, abbreviated periods of bedrest, decreased use of intensive care units, earlier return to school, fewer tests, and a lower transfusion threshold. New algorithms are now available to assist in management.