The incidence of delayed splenic bleeding in pediatric blunt trauma.

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.

• Authors: David M Notrica, Lois W Sayrs, Amina Bhatia, Robert W Letton, Adam Alder, Shawn St Peter, Todd A Ponsky, James W Eubanks 3rd, Karla A Lawson, Daniel J Ostlie, David W Tuggle, Nilda M Garcia, R Todd Maxson, Charles Leys, Cynthia Greenwell
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 53 Issue 2 Pg. 339-343 (Feb 2018) ISSN: 1531-5037 [Electronic] United States
• PMID: 29079311 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Hemorrhage (epidemiology, etiology)
• Humans
• Incidence
• Infant
• Infant, Newborn
• Male
• Prognosis
• Prospective Studies
• Spleen (injuries)
• Splenectomy (statistics & numerical data)
• Splenic Diseases (epidemiology, etiology)
• Trauma Centers (statistics & numerical data)
• Treatment Outcome
• Wounds, Nonpenetrating (complications, diagnosis, therapy)