Contemporary Management of Pediatric Blunt Splenic Trauma: A National Trauma Databank Analysis

Abstract

Purpose: To quantify changes in the management of pediatric patients with isolated splenic injury from 2007 to 2015.Materials and Methods: Patients under 18 years old with registered splenic injury in the National Trauma Data Bank (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) were identified. Splenic injuries were categorized into 5 management types: nonoperative management (NOM), embolization, splenic repair, splenectomy, or a combination therapy. Linear mixed models accounting for confounding variables were used to examine the direct impact of management on length of stay (LOS), intensive care unit (ICU) days, and ventilator days.Results: Of included patients (n ¼ 24,128), 90.3% (n ¼ 21,789), 5.6% (n ¼ 1,361), and 2.7% (n ¼ 640) had NOM, splenectomy, and embolization, respectively. From 2007 to 2015, the rate of embolization increased from 1.5% to 3.5%, and the rate of splenectomy decreased from 6.9% to 4.4%. Combining injury grades, NOM was associated with the shortest LOS (5.1 days), ICU days (1.9 days), and ventilator days (0.5 day). Moreover, splenectomy was associated with longer LOS (10.1 days), ICU days (4.5 days), and ventilator days (2.1 days) than NOM. The average failure rate of NOM was 1.5% (180 failures/12,378 cases). Average embolization failure was 1.3% (6 failures/456 cases). Splenic artery embolization was associated with lower mortality than splenectomy (OR: 0.10, P <.001). No statistically significant difference was observed in mortality between embolization and NOM (OR: 0.96, P ¼ 1.0). Conclusions:In pediatric splenic injury, NOM is the most utilized and associated with favorable outcomes, most notably in grades III to V pediatric splenic injury. If intervention is needed, embolization is effective and increasingly utilized most significantly in lower grade injuries.Trauma due to unintentional injury is the leading cause of death in children in the United States (1,2). Blunt trauma is the most common injury (due to falls, motor vehicle injuries, and being struck by an object), and the spleen is one of the most frequently injured intra-abdominal solid organs (3). Isolated splenic injury in blunt trauma accounts for From the Department of Radiology and Imaging Sciences (K.