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ObjectiveThe authors assessed the risks of nonoperative management of solid visceral injuries in children (age range, 4 months-14 years) who were consecutively admitted to a level pediatric trauma center during a 6-year period ending in 1991. MethodOne hundred seventy-nine children (5.0%) sustained injury to the liver or spleen. Nineteen children (1 1.2%) died. Of the 160 children who survived, 4 received emergency laparotomies; 156 underwent diagnostic computer tomography and were managed nonoperatively. The percentage of children who were successfully treated nonoperatively was 97.4%. Delayed diagnosis of enteric perforations occurred in two children. Fifty-three children (34.0%) received transfusions (mean volume 16.7 mL/kg); however, transfusion rates during the latter half of the study decreased from 50% to 19% in children with hepatic injuries, despite increasing grade of injury, and decreased from 57% to 23% in the splenic group with similar injury grade (p < 0.005, chi square test and Student's t test). ConclusionPediatric blunt hepatic and splenic trauma is associated with significant mortality. Nonoperative management based on physiologic parameters, rather than on computed tomography grading of organ injury, was highly successful, with few missed injuries and a low transfusion rate.It is common practice to forgo operative management of pediatric blunt hepatic and splenic injuries for more expectant therapy based on the physiologic status of the child rather than the anatomic nature of the injury. Previous reports have confirmed the efficacy of this approach,'16 but concerns remain about the ability of radiologic imaging to provide a diagnosis of all intraabdominal injuries. In addition, because of the growing Address reprint requests to Sheldon J. Bond, M.D., Division of Pediatric Surgery, Department of Surgery, University of Louisville, Louisville, KY 40292. Accepted for publication July 27, 1995. 286concern oftransmitting diseases through the use ofblood products, many question whether nonoperative management results in excessive transfusion rates. In an attempt to answer these questions and to examine the overall efficacy of treating blunt hepatic and splenic injuries in children nonoperatively, a review of our most recent experience was undertaken.

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