Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline.
OBJECTIVE
To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries.


METHODS
A chart review.


METHODS
Winnipeg Children's Hospital.


METHODS
All patients with splenic injuries under the age of 17 years admitted to the hospital between December 1994 and April 1999.


METHODS
These included patient demographics, length of stay, location of care, grade of splenic injury (American Association for the Surgery of Trauma Organ Injury Scale), imaging tests performed in hospital and after discharge, follow-up care and time to return to full activity.


RESULTS
Forty-four patients received nonoperative management. The mean age of the patients was 10.4 years. The average grade of splenic injury was 2.8. Sixteen patients (36%) were admitted to the intensive care unit for an average of 1.9 days. Mobilization was allowed after a mean of 5.2 days. Average length of hospital stay was 9.2 days. At the time of admission 98% of the patients underwent computed tomography, but at follow-up only 20% of patients underwent this investigation. None of the follow-up imaging studies altered the postdischarge management plan. The median time to full activity was 12 weeks (range from 0-17 wk). One patient had a delayed hemorrhage and required splenectomy.


CONCLUSIONS
Reduced admissions to the intensive care unit, shorter overall stays, omission of follow-up imaging and an earlier return to full activity should be considered in the management of children with blunt splenic injuries. Standardization of nonoperative care for such children would result in safe and more efficient delivery of health care.
Zabolotny
Brent
B
Department of Surgery, Children's Hospital of Winnipeg, Man.
Hancock
B J
BJ
Postuma
Ray
R
Wiseman
Nathan
N
D000293:Adolescent; D000465:Algorithms; D002170:Canada; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D008297:Male; D010347:Patient Care Planning / Q000458:organization & administration*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012449:Safety / Q000592:standards; D012720:Severity of Illness Index; D013154:Spleen / Q000293:injuries*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000175:diagnosis / Q000628:therapy*