David M Notrica1, Lois W Sayrs2, Amina Bhatia3, Robert W Letton4, Adam Alder5, Shawn St Peter6, Todd A Ponsky7, James W Eubanks8, Karla A Lawson9, Daniel J Ostlie10, David W Tuggle9, Nilda M Garcia9, R Todd Maxson11, Charles Leys12, Cynthia Greenwell5. 1. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016. Electronic address: dnotrica@phoenixchildrens.com. 2. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016. 3. Children's Healthcare of Atlanta, 1975 Century Blvd NE#6, Atlanta, GA, USA 30345. 4. The Children's Hospital at OU Medical Center, 940 NE 13th St, #1b1306, Oklahoma City, OK, USA, 73104. 5. Children's Medical Center, part of Children's Health(SM), 1935 Medical District Dr, Dallas, TX, USA 75235. 6. Mercy Children's Hospital, 2401 Gilham Rd, Kansas City, MO, USA 64108. 7. Akron Children's Hospital, 1 Perkins Sq, Akron, OH, USA 44308. 8. Le Bonheur Children's Hospital, 50 N Dunlap St, Memphis, TN, USA 38103. 9. Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX, USA 78723. 10. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016; American Family Children's Hospital, 1675 Highland Ave, Madison, WI, USA 53792. 11. Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, USA 72202. 12. American Family Children's Hospital, 1675 Highland Ave, Madison, WI, USA 53792.
Abstract
BACKGROUND: One of the concerns associated with nonoperative management of splenic injury in children has been delayed splenic bleed (DSB) after a period of hemostasis. This study evaluates the incidence of DSB from a multicenter 3-year prospective study of blunt splenic injuries (BSI). METHODS: A 3-year prospective study was done to evaluate nonoperative management of pediatric (≤18years) BSI presenting to one of 10 pediatric trauma centers. Patients were tracked at 14 and 60days. Descriptive statistics were used to summarize patient and injury characteristics. RESULTS: During the study period, 508 children presented with BSI. Median age was 11.6 [IQR: 7.0, 14.8]; median splenic injury grade was 3 [IQR: 2, 4]. Nonoperative management was successful in 466 (92%) with 18 (3.5%) patients undergoing splenectomy at the index admission, all within 3h of injury. No patient developed a delayed splenic bleed. At least one follow-up visit was available for 372 (73%) patients. CONCLUSION: A prior single institution study suggested that the incidence of DSB was 0.33%. Based on our results, we believe that the rate may be less than 0.2%. LEVEL OF EVIDENCE: Level II, Prognosis.
BACKGROUND: One of the concerns associated with nonoperative management of splenic injury in children has been delayed splenic bleed (DSB) after a period of hemostasis. This study evaluates the incidence of DSB from a multicenter 3-year prospective study of blunt splenic injuries (BSI). METHODS: A 3-year prospective study was done to evaluate nonoperative management of pediatric (≤18years) BSI presenting to one of 10 pediatric trauma centers. Patients were tracked at 14 and 60days. Descriptive statistics were used to summarize patient and injury characteristics. RESULTS: During the study period, 508 children presented with BSI. Median age was 11.6 [IQR: 7.0, 14.8]; median splenic injury grade was 3 [IQR: 2, 4]. Nonoperative management was successful in 466 (92%) with 18 (3.5%) patients undergoing splenectomy at the index admission, all within 3h of injury. No patient developed a delayed splenic bleed. At least one follow-up visit was available for 372 (73%) patients. CONCLUSION: A prior single institution study suggested that the incidence of DSB was 0.33%. Based on our results, we believe that the rate may be less than 0.2%. LEVEL OF EVIDENCE: Level II, Prognosis.
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165