Risk factors for splenectomy in children with blunt splenic trauma.
OBJECTIVE
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.
Potoka
Douglas A
DA
Department of Surgery, University of Pittsburgh and Children's Hospital of Pittsburgh and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Schall
Laura C
LC
Ford
Henri R
HR
D000063:Accidents, Traffic; D000293:Adolescent; D000367:Age Factors; D001642:Bicycling; D002648:Child; D002675:Child, Preschool; D019992:Databases as Topic; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D016013:Likelihood Functions; D018986:Motor Vehicles; D012307:Risk Factors; D013154:Spleen / Q000293:injuries* / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000601:surgery