Title

The incidence of delayed splenic bleeding in pediatric blunt trauma.

Document Type

Article

Publication Date

2-1-2018

Identifier

DOI: 10.1016/j.jpedsurg.2017.10.005

Abstract

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 Title

Journal of pediatric surgery

Volume

53

Issue

2

First Page

339

Last Page

343

MeSH Keywords

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

Keywords

Abdominal trauma; Blunt trauma; Delayed bleed; Injury; Pediatric; Splenic injury

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