Embolization for pediatric blunt splenic injury is an alternative to splenectomy when observation fails

Abstract

Therapeutic study, level IV.

Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

“…Although the role of SAE has been firmly established in adults as a treatment option for those who fail nonoperative management of splenic injury, its utility in the management of pediatric splenic trauma is limited. 2–7 Upon analysis of a national database, we found that embolization for high-grade splenic injury has equivalent transfusion rates, morbidity, and mortality compared with splenectomy by adjusted analysis.…”

“…In comparison, smaller studies with 15 or less patients reported no deaths. 2,3 Our study draws from a national database and provides more robust and generalizable estimates of the morbidity and mortality for this procedure.…”

“…Previous studies in children have demonstrated safety of embolization for traumatic splenic injuries, but have not provided direct comparison of two procedures. 2–4 In adults, SAE has been demonstrated to improve splenic salvage rates for grade IV and V injuries. 12 This point is especially important in the pediatric population, as children have a higher mortality rate from sepsis following splenectomy compared with adults.…”

“…Centers have relied on evidence of vascular injury on computed tomography scan, denoted by contrast blush, splenic vascular injuries, American Association for the Surgery of Trauma (AAST) grade III to V injury, and large hemoperitoneum, or active extravasation of contrast as signs that embolization is warranted. 2,5,6,8,26–32 We sought to compare outcomes of SAE vs splenectomy in children with isolated splenic injuries; however, the database lacked granularity for direct analysis. Finally, the radiation dosing was not known for embolization procedures in our series.…”

“…1 For several decades, nonoperative management of most children with blunt splenic injury has been considered the standard of care. 2–5 Such an approach has obviated the need for splenectomy in over 90% of pediatric patients who sustain blunt splenic injury, avoiding the risk of overwhelming postsplenectomy sepsis. 6,7 Moreover, splenic preservation after blunt injury has been associated with reductions in blood transfusion requirement, healthcare resource utilization, and postinjury mortality rates.…”