title: Risk of hemorrhage and appropriate use of blood transfusions in pediatric blunt splenic injuries.
abstract: OBJECTIVE
  To define changes in hematocrit (Hct) and the indications for blood transfusion in pediatric blunt splenic injury.
  
  
  METHODS
  Retrospective case series
  
  
  METHODS
  All children with blunt splenic injuries from 1990 to 1995 were studied (n = 74). Transfusion practices were reviewed for the whole group. Thirty children with isolated splenic injuries who were not transfused were analyzed to document Hct changes (mean +/- 95% confidence intervals).
  
  
  RESULTS
  The Hct at presentation was 37 +/- 2%, which rapidly dropped to 31 +/- 2% (p < 0.05) within 24 hours. After remaining stable at that level for the next 5 days, the Hct rose to 33 +/- 4% on day 6 (p = not significant), 35 +/- 4% on day 7 (p = not significant), and 38 +/- 2% (p = not significant) on day 13 +/- 3. Fifteen children received transfusions, all but one of whom had suffered multiple injuries. The transfusion rate declined from 38% of children in 1990 to 10% in 1995.
  
  
  CONCLUSIONS
  After the initial drop within the first 24 hours, the Hct remains stable and rises with time to reach the baseline by day 6. Transfusion rates have declined over time, and transfusions are now used almost exclusively in severely injured children with multiple injuries.
authors.affiliation: Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, and the Children's Hospital of Buffalo, 14222, USA.
authors.forename: S
authors.initials: S
authors.lastname: Shafi
authors.forename: J C
authors.initials: JC
authors.lastname: Gilbert
authors.forename: S
authors.initials: S
authors.lastname: Carden
authors.forename: J E
authors.initials: JE
authors.lastname: Allen
authors.forename: P L
authors.initials: PL
authors.lastname: Glick
authors.forename: M G
authors.initials: MG
authors.lastname: Caty
authors.forename: R G
authors.initials: RG
authors.lastname: Azizkhan
mesh_terms: D001803:Blood Transfusion; D002648:Child; D005260:Female; D006400:Hematocrit; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000601:surgery; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*