The incidence of delayed splenic bleeding in pediatric blunt trauma.
Background: One of the concerns associated with nonoperative management of splenic injury in children has been delayed splenic bleed (DSB) after a period of hemostasis. This study evaluates the incidence of DSB from a multicenter 3-year prospective study of blunt splenic injuries (BSI).
Methods: A 3-year prospective study was done to evaluate nonoperative management of pediatric (≤18years) BSI presenting to one of 10 pediatric trauma centers. Patients were tracked at 14 and 60days. Descriptive statistics were used to summarize patient and injury characteristics.
Results: During the study period, 508 children presented with BSI. Median age was 11.6 [IQR: 7.0, 14.8]; median splenic injury grade was 3 [IQR: 2, 4]. Nonoperative management was successful in 466 (92%) with 18 (3.5%) patients undergoing splenectomy at the index admission, all within 3h of injury. No patient developed a delayed splenic bleed. At least one follow-up visit was available for 372 (73%) patients.
Conclusion: A prior single institution study suggested that the incidence of DSB was 0.33%. Based on our results, we believe that the rate may be less than 0.2%.
Level of evidence: Level II, Prognosis.
Journal of pediatric surgery
Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Hemorrhage; Humans; Incidence; Infant; Infant, Newborn; Male; Prognosis; Prospective Studies; Spleen; Splenectomy; Splenic Diseases; Trauma Centers; Treatment Outcome; Wounds, Nonpenetrating
Abdominal trauma; Blunt trauma; Delayed bleed; Injury; Pediatric; Splenic injury
Notrica DM, Sayrs LW, Bhatia A, et al. The incidence of delayed splenic bleeding in pediatric blunt trauma. J Pediatr Surg. 2018;53(2):339-343. doi:10.1016/j.jpedsurg.2017.10.005