A cohort study to evaluate infection prevention protocol in pediatric trauma patients with blunt splenic injury in a Dutch level 1 trauma center

Abstract

PurposeAsplenic patients are at increased risk for the development of overwhelming postsplenectomy infection (OPSI) syndrome. It is believed that adequate immunization, antimicrobial prophylaxis, as well as appropriate education concerning risks on severe infection lead to the decreased incidence of OPSI. The aim of this study was to analyze the methods used to prevent OPSI in trauma patients splenectomized before the age of 18.Patients and methodsA retrospective, single-center study of all pediatric patients sustaining blunt splenic injury (BSI) managed at our level 1 trauma center from January 1979 to March 2012 was performed. A questionnaire was sent to all the included patients to determine the level of knowledge concerning infection risks, the use of antibiotics, and compliance to vaccination recommendations. Furthermore, we investigated whether the implementation of guidelines in 2003 and 2011 resulted in higher vaccination rates.ResultsWe included 116 children with BSI. A total of 93 completed interviews were eligible for analysis, resulting in a total response rate of 80% and 1,116 patient years. Twenty-seven patients were splenectomized, and 66 patients were treated by a spleen preserving therapy (including embolization). Only two out of 27 splenectomized patients were adequately vaccinated, five patients without a spleen used prophylactic antibiotics, and about half of the asplenic patients had adequate knowledge of the risk that asplenia entails. A total of 22/27 splenectomized patients were neither adequately vaccinated nor received prophylactic antibiotics. There was no OPSI seen in our study population during the 1,116 follow-up years.ConclusionThe vaccination status, the level of knowledge concerning prevention of an OPSI, and the use of prophylactic antibiotics are suboptimal in pediatric patients treated for BSI. Therefore, we created a new follow-up treatment guideline to have adequate preventive coverage to current standards for these patients.

Splenic injury severity, not admission hemodynamics, predicts need for surgery in pediatric blunt splenic trauma

“…As pediatric splenic injury grading has low inter-radiologist variability, grading is believed to be very reliable [37]. to detect a contrast blush, indication for angio-embolization in the setting of delayed hemodynamic instability.to help guide follow-up imaging, make vaccination recommendations and help estimate discharge management [38]. …”

“…to help guide follow-up imaging, make vaccination recommendations and help estimate discharge management [38].…”

Management of pediatric blunt abdominal trauma in a Dutch level one trauma center

“…The study group consisted of 83 (68%) males and 38 (31%) females, with a median age of 12 (8)(9)(10)(11)(12)(13)(14)(15)(16) and a median ISS of 16 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). On admission, the study group had a median SBR of 120 (108-130), a PR of 92 (80-110), and a GCS of 15 (14)(15). A total of 47 (39%) patients were transferred from a different hospital to the UMC Utrecht.…”

“…In this review, almost all studies that performed splenic function tests showed a preserved splenic function after AE. In case of an inadequate splenic function, the infection prevention protocol should be applied [14]. However, there is still no single parameter or test available, which can demonstrate a preserved splenic function.…”

“…Therefore, splenic preservation is even more important in younger patients. Angio-embolization could be a useful addition in the treatment protocol to achieve this higher rate of splenic preservation [13,14]. In the adult population, embolization is well accepted as the treatment of choice in some instances of hemorrhage.…”