Abstract
Splenic injury severity, not admission hemodynamics, predicts need for surgery in pediatric blunt splenic trauma
Highlights
The spleen is the most frequently injured organ in blunt abdominal trauma and blunt abdominal trauma is a frequent cause of childhood injuries [1, 2]
The current study demonstrates that nonoperative management is safe in well-equipped pediatric trauma hospitals for all hemodynamically stable pediatric patients without concomitant hollow organ or diaphragm injuries
In contrast to the current literature, this study reveals that splenic injury severity does predict persistent hemodynamic instability and the need for early operative intervention in pediatric blunt splenic injury
Summary
The spleen is the most frequently injured organ in blunt abdominal trauma and blunt abdominal trauma is a frequent cause of childhood injuries [1, 2]. The management of blunt splenic injuries (BSI) in pediatric patients has evolved over the past decades from primarily operative management to selective nonoperative management (NOM) [3,4,5]. Following reports that established the existence of a syndrome of overwhelming post splenectomy infection (OPSI), have eventually initiated the willing to preserve splenic function after trauma [7, 8]. Asplenic patients have a life time risk exceeding 5% on OPSI and this sepsis-syndrome has a mortality rate ranging between 50 and 80% [9,10,11]. Failure of NOM (fNOM), defined as the need for surgical intervention in patients that were initially selected for conservative management, is associated with increased morbidity and mortality [12,13,14]
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