The use and timing of angioembolization in pediatric blunt liver and spleen injury.
Document Type
Article
Publication Date
6-1-2024
Identifier
DOI: 10.1097/TA.0000000000004228
Abstract
BACKGROUND: Nonoperative management (NOM) is the standard of care for the management of blunt liver and spleen injuries (BLSI) in the stable pediatric patient. Angiography with embolization (AE) is used as an adjunctive therapy in the management of adult BLSI patients, but it is rarely used in the pediatric population. In this planned secondary analysis, we describe the current utilization patterns of AE in the management of pediatric BLSI.
METHODS: After obtaining IRB approval at each center, cohort data was collected prospectively for children admitted with BLSI confirmed on CT at 10 Level I pediatric trauma centers (PTCs) throughout the United States from April 2013 to January 2016. All patients who underwent angiography with or without embolization for a BLSI were included in this analysis. Data collected included patient demographics, injury details, organ injured and grade of injury, CT finding specifics such as contrast blush, complications, failure of NOM, time to angiography and techniques for embolization.
RESULTS: Data were collected for 1004 pediatric patients treated for BLSI over the study period, 30 (3.0%) of which underwent angiography with or without embolization for BLSI. Ten of the patients who underwent angiography for BLSI failed NOM. For patients with embolized splenic injuries, splenic salvage was 100%. Four of the nine patients undergoing embolization of the liver ultimately required an operative intervention, but only one patient required hepatorrhaphy and no patient required hepatectomy after AE. Few angiography studies were obtained early during hospitalization for BLSI, with only one patient undergoing angiography within 1 hour of arrival at the PTC, and 7 within 3 hours.
CONCLUSION: Angioembolization is rarely used in the management of BLSI in pediatric trauma patients with blunt abdominal trauma and is generally used in a delayed fashion. However, when implemented, angioembolization is associated with 100% splenic salvage for splenic injuries.
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.
Journal Title
J Trauma Acute Care Surg
Volume
96
Issue
6
First Page
915
Last Page
920
MeSH Keywords
Humans; Embolization, Therapeutic; Wounds, Nonpenetrating; Spleen; Child; Male; Female; Liver; Adolescent; Angiography; Child, Preschool; Tomography, X-Ray Computed; Trauma Centers; Injury Severity Score; Abdominal Injuries; Treatment Outcome; United States; Prospective Studies
Keywords
Therapeutic Embolization; Nonpenetrating Wounds; Spleen; Liver; Angiography; X-Ray Computed Tomography; Trauma Centers; Injury Severity Score; Abdominal Injuries; Treatment Outcome; United States; Prospective Studies
Recommended Citation
Naiditch JA, Notrica DM, Sayrs LW, et al. The use and timing of angioembolization in pediatric blunt liver and spleen injury. J Trauma Acute Care Surg. 2024;96(6):915-920. doi:10.1097/TA.0000000000004228
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