Natural history of nonoperative management for grade 4 and 5 liver and spleen injuries in children.
Document Type
Article
Publication Date
12-1-2008
Identifier
DOI: 10.1016/j.jpedsurg.2008.08.059
Abstract
PURPOSE: Nonoperative management is standard treatment of blunt liver or spleen injuries. However, there are few reports outlining the natural history and outcomes of severe blunt hepatic and splenic trauma. Therefore, we reviewed our experience with nonoperative management of grade 4 or 5 liver and spleen injuries.
METHODS: A retrospective analysis was performed on patients with grade 4 or 5 (high-grade) blunt liver and/or spleen injuries from April 1997 to July 2007 at our children's hospital. Demographics, hospital course data, and follow-up data were analyzed.
RESULTS: There were 74 high-grade injuries in 72 patients. There were 30 high-grade liver and 44 high-grade spleen injuries. Two patients had both a liver and splenic injury. High-grade liver injuries had a significantly longer length of intensive care and hospital stay compared to high-grade spleen injuries. There were also a significantly higher number of transfusions, radiographs, and total charges in the high-grade liver injuries when compared to the high-grade splenic injuries. The only mortality from solid organ injury was a grade 4 liver injury with portal vein disruption. In contrast, there was only one complication from a high-grade splenic injury-a pleural effusion treated with thoracentesis. There were 5 patients with complications from their liver injury requiring 18 therapeutic procedures. Three patients (10%) with liver injury required readmission as follows: one 5 times, one 3 times, and another one time.
CONCLUSIONS: Patients with high-grade liver injuries have a longer recovery, more complications, and greater use of resources than in patients with similar injuries to the spleen.
Journal Title
Journal of pediatric surgery
Volume
43
Issue
12
First Page
2264
Last Page
2267
MeSH Keywords
Accidents; Bed Rest; Biliary Tract Diseases; Blood Transfusion; Child; Child Abuse; Child, Preschool; Craniocerebral Trauma; Follow-Up Studies; Humans; Length of Stay; Liver; Multiple Trauma; Organ Specificity; Pancreatitis; Pleural Effusion; Radiography; Retrospective Studies; Spleen; Trauma Severity Indices; Wounds, Nonpenetrating
Keywords
Child Abuse; Spleen Trauma; Nonpenetrating wounds
Recommended Citation
Yang, J. C., Sharp, S. W., Ostlie, D. J., Holcomb, G. W., St Peter, S. D. Natural history of nonoperative management for grade 4 and 5 liver and spleen injuries in children. Journal of pediatric surgery 43, 2264-2267 (2008).
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