Splenic injury in children after blunt trauma: Blood transfusion requirements and length of hospitalization for laparotomy versus observation

Abstract

Nonoperative management (observation) of blunt injury to the spleen under the appropriate conditions has been shown to be successful and safe. However, concern has been raised that this approach may lead to longer hospitalizations and more frequent and greater volumes of blood transfusion and, therefore, increased risk of blood-borne infection when compared with laparotomy for blunt splenic injury. At the University of California, Davis Medical Center, two separate management teams provide trauma care to patients under 16 years of age, one of which is more oriented to nonoperative care. This provided the opportunity for a retrospective review in which length of hospitalization and blood transfusion requirements were compared for patients undergoing laparotomy and those being observed. From July 1988 to January 1992, 36 patients under the age of 16 were evaluated after blunt trauma and found to have an injury to the spleen. Eleven children were managed nonoperatively. The mechanisms of injury were similar in the operative and nonoperative groups. The average age and hematocrit for the operative and nonoperative groups (respectively) were 9.1 years, 30.6 g%, and 6.9 years, 34.4 g%. Comparing the operative and laparotomy groups, the length of hospital stay (9.9 v 8.4 days) and intensive care unit stay (5.1 v 4.3 days) were similar. The average blood transfusion volume for the observed group was 0.5 U compared with 5.3 U for the laparotomy group. A subgroup of patients (n = 9) who were stable but underwent abdominal exploration received an average of 1.4 U. There was a statistically significant decrease in blood transfusion volumes when comparing the observed and operated group ( P < .01). However, there was no significant difference between the stable-but-operated group and the observed group. Thus, children with splenic injury from blunt trauma who are stable at the time of initial evaluation do not require longer hospitalizations or greater volumes of transfused blood.