Physiology after Pediatric Splenic Injury

Mooney, David P.; Downard, Cynthia D.; Johnson, Sidney M.; Atkinson, Carole C.; Forbes, Peter; Taylor, George T.

doi:10.1097/01.ta.0000153746.76095.03

Cited by 9 publications

(3 citation statements)

References 4 publications

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“…Review of the NPTR and recent surveys of the American Pediatric Surgical Association (APSA) membership confirm the wide disparity in practice [7]. Controversy also exists regarding the utility of CT grading and the finding of contrast blush as predictors of outcome in liver and spleen injury [8][9][10][11][12]. A recent report indicates that standard physiologic parameters correlate directly with CT grade [12].…”

Section: Spleen and Livermentioning

confidence: 95%

“…Controversy also exists regarding the utility of CT grading and the finding of contrast blush as predictors of outcome in liver and spleen injury [8][9][10][11][12]. A recent report indicates that standard physiologic parameters correlate directly with CT grade [12]. Several recent studies have reported rates of contrast blush on CT of 7-12% in 365 children with blunt spleen injury [13][14][15].…”

Section: Spleen and Livermentioning

confidence: 97%

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Outcomes from pediatric solid organ injury: role of standardized care guidelines

Stylianos

2005

Current Opinion in Pediatrics

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Clinical experience and published reports addressing specific concerns about the nonoperative treatment of children with solid organ injuries and recent radiologic and endoscopic contributions have made pediatric trauma care increasingly nonoperative. Although the trend is in this direction, the pediatric surgeon should remain the physician-of-record in the multidisciplinary care of critically injured children.

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Section: Spleen and Livermentioning

confidence: 95%

Section: Spleen and Livermentioning

confidence: 97%

Outcomes from pediatric solid organ injury: role of standardized care guidelines

Stylianos

2005

Current Opinion in Pediatrics

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“…[2][3][4] Currently acceptable splenectomy rates range from 5 to 11 per cent for all trauma patients (which includes patients who have multiple injuries) and zero to three per cent for patients presenting with isolated splenic trauma. [5][6][7][8][9] Like in adults, the benefits of NOM include avoidance of surgical morbidity, decreased pain, and shorter hospital stay and decreased healthcare costs. 10 Even more important in children is the threat of overwhelming postsplenectomy sepsis.…”

mentioning

confidence: 99%

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

Day

Steigman

Aidlen

et al. 2014

The American Surgeon

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Nonoperative management of hemodynamically stable blunt splenic injury (BSI) is the gold standard in children. Recent studies from nonpediatric surgery-specialized trauma centers have demonstrated a rise in transfusion and angioembolization associated with decreased splenectomy rates. We investigate the rate of splenectomy and nonsurgical interventions (angioembolization, blood transfusion) for BSI in a pediatric surgery-specialized trauma center. We conducted a retrospective review of children (0 to 18 years) treated between September 2001 and September 2011 at a children's hospital. Analyzed data included presenting vital signs, nadir hemoglobin, splenic injury grade, Revised Trauma Score, and Injury Severity Score (ISS). Measured outcomes included transfusion, angioembolization, and splenectomy rates. The study period was divided into three time periods to identify possible trends and compared with national averages. There were 180 patients, 91 with multiple injuries (50.6%) and 89 (49.4%) with isolated BSI. Seventy-six per cent of patients were male, average age was 12.8 years, and average ISS was 14.7. The overall splenectomy rate was 1.7 per cent (1.1% for isolated splenic injury). Our angioembolization rate was 0.6 per cent compared with 7.4 to 16 per cent nationally. Our transfusion rate was 14.4 per cent overall and 5.6 per cent for isolated splenic injury compared with 9.5 to 24.9 per cent nationally. Intervention rates remained unchanged over the study period. Splenectomy rates have remained low at our institution without an increase in angioembolization or transfusion. Children with splenic injuries treated at dedicated pediatric hospitals can be successfully managed nonoperatively without angioembolization or blood transfusion.

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Pediatric Surgery

Martin¹,

Cunningham²,

Jafri³

2018

Surgical Critical Care and Emergency Surgery

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Physiology after Pediatric Splenic Injury

Abstract: The CT grade of splenic injury correlates directly with pulse, systolic blood pressure, and diastolic blood pressure and inversely with hematocrit. CT injury grade correlates with physiologic impact and may guide management decisions.

Cited by 9 publications

References 4 publications

Outcomes from pediatric solid organ injury: role of standardized care guidelines

Outcomes from pediatric solid organ injury: role of standardized care guidelines

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

Pediatric Surgery

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