Outcomes of pediatric blunt liver and spleen injury in 1029 patients using the ATOMAC+ pediatric trauma research network guideline.

Creator(s)

• David M. Notrica
• Todd Maxson
• Rachael L. Stottlemyre
• Aaron S. Cohen
• Nikkida Bundrant
• Karla A. Lawson
• James W. Eubanks
• Mark Ryan, Children's Mercy Kansas CityFollow
• Robert W. Letton
• Amina Bhatia
• Deidre Wyrick
• Shawn D. St Peter, Children's Mercy HospitalFollow
• Charles Leys
• Todd Ponsky
• Regan F. Williams
• Jeremy J. Johnson

Document Type

Article

Publication Date

7-2026

Identifier

DOI: 10.1016/j.jpedsurg.2026.163107

Abstract

BACKGROUND: The ATOMAC + guideline is an evidence-based guideline for management of pediatric blunt liver and/or spleen injury (BLSI) based on clinical signs of bleeding on arrival.

METHODS: A prospective multi-institutional study of children aged ≤18 years with BLSI was conducted at 10 pediatric trauma centers. Unstable patients without computed tomography were added retrospectively. Demographic data, interventions, and outcomes were analyzed.

RESULTS: Of 1029 children (median age 10.2 years) with BLSI, 713 (69%) had no signs of clinically significant bleeding upon arrival, and no initially stable patients required surgery for bleeding; 13 (1.8%) required abdominal surgery for other reasons. Of 316 patients with clinical signs of recent bleeding or ongoing bleeding on arrival, 10 patients died in the ED and 17 non-responders underwent surgery directly. Among 168 patients responding initially to transfusion, 22 underwent angiography and 60 went to surgery (9 after angiography). Of the 44 stabilized patients who received >40 mL/kg blood products, only 5 (11%) survived without intervention. Additionally, 37 (32%) transfused patients not meeting this threshold also underwent abdominal intervention. Overall mortality was 3.4% including 21% of 42 patients transfused >40 mL/kg or 4 units of blood.

CONCLUSION: The frequency of laparotomy or laparoscopy in children with BLSI was 8.2%. Children with no clinical signs of bleeding upon arrival did not later bleed, but 1.6% of these patients ultimately required abdominal surgery for other injuries. Transfusion >40 mL/kg was strongly associated with intervention or death, but a substantial number of children who received less blood also required intervention.

Journal Title

Journal of pediatric surgery

Volume

61

Issue

7

First Page

163107

Last Page

163107

MeSH Keywords

Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Abdominal Injuries; Blood Transfusion; Hemorrhage; Injury Severity Score; Liver; Practice Guidelines as Topic; Prospective Studies; Spleen; Trauma Centers; Treatment Outcome; Wounds, Nonpenetrating

PubMed ID

41887567

Keywords

ATOMAC; Blunt trauma; Guideline; Liver injury; Pediatric trauma; Spleen injury; Trauma

Recommended Citation

Notrica DM, Maxson T, Stottlemyre RL, et al. Outcomes of pediatric blunt liver and spleen injury in 1029 patients using the ATOMAC+ pediatric trauma research network guideline. J Pediatr Surg. 2026;61(7):163107. doi:10.1016/j.jpedsurg.2026.163107