title: Factors predicting the need for splenectomy in children with blunt splenic trauma.
abstract: OBJECTIVE
  Non-operative management of blunt splenic trauma (BST) in children is the standard of care with a success rate of greater than 90%. This paper aims to determine the factors which could predict the need for operative intervention in children with BST.
  
  
  METHODS
  Prospectively entered data of 69 children with BST, between 1997 and 2008, from a single tertiary level trauma centre, were retrospectively analysed. A radiologist blinded to the outcome reviewed all computed tomography scans retrospectively.
  
  
  RESULTS
  Forty-two children had isolated BST (61%) and 27 children had associated injuries (39%). All except one survived the injury and non-operative treatment was successful in 91%. Six of the 69 children (9%) with BST underwent splenectomy. There was no independent correlation to age, gender, mechanism of injury (MOI), injury grade and the need for splenectomy, whereas haemodynamic instability within 6 h of injury defined as failed resuscitation had a 100% correlation.
  
  
  CONCLUSIONS
  Haemodynamic instability, which failed to respond to resuscitation within 6 h, predicted the need for splenectomy in children with BST. Splenic injury grade assessed by computed tomography scan does not predict the need for splenectomy.
authors.affiliation: Department of Paediatric Surgery, John Hunter Children's Hospital, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Anton E A
authors.initials: AE
authors.lastname: Fick
authors.forename: Prasenjit
authors.initials: P
authors.lastname: Raychaudhuri
authors.forename: John
authors.initials: J
authors.lastname: Bear
authors.forename: Gerrad
authors.initials: G
authors.lastname: Roy
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Balogh
authors.forename: Rajendra
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery