Conservative approach to the treatment of injured liver and spleen in children: association with reduced mortality.
BACKGROUND
Previous analyses of the safety of the conservative versus the operative approach to the treatment of liver and spleen blunt injuries in children often failed to account for differences in quality of care and expertise among dedicated pediatric trauma center, non-pediatric centers, centers without trauma units, and non-trauma centers. To eliminate this potential bias, the present study examined changes in the rate of surgery and their impact on outcome within the same medical centers over time.


METHODS
The Israel Trauma Registry was searched for patients <18 years who were treated for non-penetrating liver or spleen injuries from 1998 to 2004. Patients were grouped by period, 1998-2000 and 2001-2004, and compared for type of injury, severity of injury, type of treatment, and inpatient mortality.


RESULTS
The earlier period (1998-2000) was characterized by a significantly higher rate of operations compared with the later period (2001-2004) (P = 0.001) and higher in-hospital mortality (P = 0.04). Injury severity scores, type of organs injured, and accompanying injuries were similarly distributed in the two groups.


CONCLUSIONS
Despite the similarity in the severity and characteristics of the intraabdominal injuries in 1998-2000 and in 2001-2004, the proportion of children treated conservatively increased over time, concomitant with a significant drop in inpatient mortality. We attribute this shift over a relatively short interval to increased experience and greater acceptance of conservative management in this setting.
Feigin
Elad
E
Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tiqwa 49202, Israel. eladf@clalit.org.il
Aharonson-Daniel
Limor
L
Savitsky
Bela
B
Steinberg
Ran
R
Kravarusic
Dragan
D
Stein
Michael
M
Peleg
Kobi
K
Freud
Enrique
E
D000007:Abdominal Injuries / Q000601:surgery / Q000628:therapy*; D000293:Adolescent; D002648:Child; D006801:Humans; D007557:Israel; D007902:Length of Stay; D008099:Liver / Q000293:injuries* / Q000601:surgery; D012042:Registries; D012720:Severity of Illness Index; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*