Risk factors for splenectomy in children with blunt splenic trauma

Douglas A. Potoka, Laura C. Schall, Henri Ford

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background/Purpose: Nonoperative management and splenic preservation have become standards of care for management of pediatric blunt splenic trauma. However, review of the Pennsylvania Trauma Outcome Study (PTOS) registry found that 15% of children with blunt splenic injury still underwent splenectomy. The authors sought to determine the factors that predisposed to splenectomy in this population. Methods: Between 1993 and 1997, 754 children, ages 0 to 16 years, who sustained blunt splenic trauma were entered in the PTOS database. These patients were stratified into groups according to the mode of management: nonoperative, splenorrhaphy, or splenectomy. Logistic regression was performed to determine factors associated with splenectomy. Results: Overall, 15.1% of patients underwent splenectomy, 7.4% underwent splenorrhaphy, and 77.5% were treated nonoperatively. Spleen injury grade, nonspleen abdominal injuries, Glasgow Coma Scale 3 to 8, and age 15 to 16 years were significant determinants of splenectomy by multivariate analysis. Children treated at pediatric trauma centers (PTC) underwent significantly fewer splenectomies. Conclusions: Injury grade, but not hemodynamic instability, was a significant independent determinant of splenectomy in children with blunt splenic trauma. Children treated at PTC are less likely to undergo splenectomy. Ongoing analysis of the management of blunt pediatric splenic injury and reduction of unnecessary splenectomies are needed to optimize care for injured children.

Original languageEnglish (US)
Pages (from-to)294-299
Number of pages6
JournalJournal of Pediatric Surgery
Volume37
Issue number3
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

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Splenectomy
Wounds and Injuries
Pediatrics
Trauma Centers
Outcome Assessment (Health Care)
Abdominal Injuries
Nonpenetrating Wounds
Glasgow Coma Scale
Standard of Care
Child Care
Registries
Spleen
Multivariate Analysis
Logistic Models
Hemodynamics
Databases

Keywords

  • Nonoperative management
  • Pediatric trauma
  • Splenectomy
  • Splenic trauma
  • Splenorrhaphy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Risk factors for splenectomy in children with blunt splenic trauma. / Potoka, Douglas A.; Schall, Laura C.; Ford, Henri.

In: Journal of Pediatric Surgery, Vol. 37, No. 3, 01.01.2002, p. 294-299.

Research output: Contribution to journalArticle

Potoka, Douglas A. ; Schall, Laura C. ; Ford, Henri. / Risk factors for splenectomy in children with blunt splenic trauma. In: Journal of Pediatric Surgery. 2002 ; Vol. 37, No. 3. pp. 294-299.
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abstract = "Background/Purpose: Nonoperative management and splenic preservation have become standards of care for management of pediatric blunt splenic trauma. However, review of the Pennsylvania Trauma Outcome Study (PTOS) registry found that 15{\%} of children with blunt splenic injury still underwent splenectomy. The authors sought to determine the factors that predisposed to splenectomy in this population. Methods: Between 1993 and 1997, 754 children, ages 0 to 16 years, who sustained blunt splenic trauma were entered in the PTOS database. These patients were stratified into groups according to the mode of management: nonoperative, splenorrhaphy, or splenectomy. Logistic regression was performed to determine factors associated with splenectomy. Results: Overall, 15.1{\%} of patients underwent splenectomy, 7.4{\%} underwent splenorrhaphy, and 77.5{\%} were treated nonoperatively. Spleen injury grade, nonspleen abdominal injuries, Glasgow Coma Scale 3 to 8, and age 15 to 16 years were significant determinants of splenectomy by multivariate analysis. Children treated at pediatric trauma centers (PTC) underwent significantly fewer splenectomies. Conclusions: Injury grade, but not hemodynamic instability, was a significant independent determinant of splenectomy in children with blunt splenic trauma. Children treated at PTC are less likely to undergo splenectomy. Ongoing analysis of the management of blunt pediatric splenic injury and reduction of unnecessary splenectomies are needed to optimize care for injured children.",
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