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, D. M., Sayrs, L. W., Bhatia, A., Letton, R. W., Alder, A., St Peter, S. D., Ponsky, T. A., Eubanks, J. W., Lawson, K. A., Ostlie, D. J., Tuggle, D. W., Garcia, N. M., Maxson, R. T., Leys, C., Greenwell, C. The incidence of delayed splenic bleeding in pediatric blunt trauma. Journal of pediatric surgery 53, 339-343 (2018).