title: Splenic artery embolisation in children and adolescents--an 8 year experience.
abstract: BACKGROUND
  Non-operative management (NOM) is the treatment of choice in blunt splenic injuries in the paediatric population, with reported success rates exceeding 90%. Splenic artery embolisation (SAE) was added to our institutional treatment protocol for splenic injury in 2002. We wanted to review indications for SAE and the clinical outcome of splenic injury management in children admitted between August 1, 2002 and July 31, 2010.
  
  
  METHODS
  Patients aged <17 years with splenic injury were identified in the institutional trauma and medical code registries. Patient charts and computed tomographic (CT) scans were reviewed.
  
  
  RESULTS
  Of the 72 children and adolescents with splenic injury included during the 8 year study period, 66 patients (92%) were treated non-operatively and six underwent operative management. Severe splenic injury (OIS grade 3-5) was diagnosed in 67 patients (93%). SAE was performed in 22 of the NOM patients. Indications for SAE included - bleeding (n=8), pseudoaneurysms (n=2), contrast extravasation (n=2), high OIS injury grade (n=8) and prophylactic due to specific disease (n=2). NOM was successful in all but one case (98%). For the patients aged ≤ 14 years, extravasation on initial CT scan correlated to delayed bleeding (p<0.001). Two SAE procedure specific complications were registered, but resolved without significant sequelae.
  
  
  CONCLUSIONS
  After SAE was added to the institutional treatment protocol, 22 of 66 NOM paediatric patients underwent SAE. NOM was successful in 98% and a 90% splenic preservation rate was achieved. Contrast extravasation correlated to delayed splenic bleeding in children ≤ 14 years.
authors.affiliation: Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424 Oslo, Norway. Electronic address: joet@uus.no.
authors.forename: Jorunn
authors.initials: J
authors.lastname: Skattum
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.forename: Paal Aksel
authors.initials: PA
authors.lastname: Naess
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009664:Norway / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries / Q000503:physiopathology*; D013157:Splenic Artery / Q000293:injuries / Q000503:physiopathology*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy*
keywords: Non-operative management; Paediatric; Splenic artery embolisation; Splenic injury