Scholarlink

Background <p>Nonoperative management (NOM) is the standard for pediatric splenic trauma, yet care disparities persist. This study analyzed NOM outcomes in a specialized pediatric trauma center and modeled strategies in settings without interventional radiology (IR).</p> Methods <p>A retrospective study of pediatric patients (0–14&#xa0;years) with blunt splenic injury (2010–2024) was conducted. Actual splenectomy rates (Group 1: specialized center) were compared with hypothetical models without IR using pediatric (Group 2) and adult (Group 3) guidelines. Statistical analysis used Fisher’s exact test for categorical comparisons and Mann–Whitney U test for continuous variables (p &lt; 0.05).</p> Results <p>Forty-four patients were included. The splenectomy rate for Group 1 was 11.4% (5/44), compared to a predicted 15.9% (7/44) for Group 2 and 31.8% (14/44) for Group 3. Differences were not statistically significant after Bonferroni correction. Factors most strongly associated with splenectomy were hemodynamic instability (<i>p</i> &lt; 0.0001), a higher AAST injury grade (<i>p</i> &lt; 0.0001), and a significantly higher Injury Severity Score (ISS) (median 43 vs. 13, <i>p</i> = 0.0002). This higher baseline severity was reflected in outcomes, with the splenectomy group requiring significantly longer hospitalization (median 46 vs. 15&#xa0;days, <i>p</i> = 0.0031). One death occurred (severe traumatic brain injury).</p> Conclusion <p>Our study highlights that hemodynamic instability, high-grade anatomical injury, and overall trauma severity (ISS) are primary factors associated with splenectomy. Our models quantify the critical role of specialized pediatric trauma centers with available interventional radiology in maximizing spleen salvage. Findings support the centralization of care to minimize unnecessary splenectomies.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Management of Pediatric Splenic Trauma: A 15-Year Single-Center Experience and a Comparative Analysis of Care Models

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月4日

查看全文
  • Z. Burešová,
  • T. Merkl,
  • A. Šafus,
  • M. Hůlek,
  • P. Kraus,
  • R. Štichhauer

摘要

Background

Nonoperative management (NOM) is the standard for pediatric splenic trauma, yet care disparities persist. This study analyzed NOM outcomes in a specialized pediatric trauma center and modeled strategies in settings without interventional radiology (IR).

Methods

A retrospective study of pediatric patients (0–14 years) with blunt splenic injury (2010–2024) was conducted. Actual splenectomy rates (Group 1: specialized center) were compared with hypothetical models without IR using pediatric (Group 2) and adult (Group 3) guidelines. Statistical analysis used Fisher’s exact test for categorical comparisons and Mann–Whitney U test for continuous variables (p < 0.05).

Results

Forty-four patients were included. The splenectomy rate for Group 1 was 11.4% (5/44), compared to a predicted 15.9% (7/44) for Group 2 and 31.8% (14/44) for Group 3. Differences were not statistically significant after Bonferroni correction. Factors most strongly associated with splenectomy were hemodynamic instability (p < 0.0001), a higher AAST injury grade (p < 0.0001), and a significantly higher Injury Severity Score (ISS) (median 43 vs. 13, p = 0.0002). This higher baseline severity was reflected in outcomes, with the splenectomy group requiring significantly longer hospitalization (median 46 vs. 15 days, p = 0.0031). One death occurred (severe traumatic brain injury).

Conclusion

Our study highlights that hemodynamic instability, high-grade anatomical injury, and overall trauma severity (ISS) are primary factors associated with splenectomy. Our models quantify the critical role of specialized pediatric trauma centers with available interventional radiology in maximizing spleen salvage. Findings support the centralization of care to minimize unnecessary splenectomies.