Embolization for pediatric blunt splenic injury is an alternative to splenectomy when observation fails.
BACKGROUND
Management of splenic injury has shifted from operative to nonoperative management in both children and adults with reports of high success rates. Benefits of splenic conservation include decreased hospital stay, blood transfusion, and mortality, as well as avoidance of infectious complications. Angiography with embolization is an innovative adjunct to nonoperative management and has resulted in increased splenic salvage in adults; however, data in the pediatric population are scant.


METHODS
A retrospective comparative study of a single-hospital trauma registry reviewed from 1999 to 2009. Patients 18 years and younger admitted with injury to the spleen were included. Children with penetrating injury were excluded. Children were divided into three categories by initial treatment: observation, embolization, or splenectomy. Data recorded include age, radiographic grade of injury, and Injury Severity Score (ISS). Groups were analyzed for success of initial treatment, requirement for transfusion of packed red blood cells, splenic salvage, and mortality.


RESULTS
Registry review identified 259 children with blunt splenic injury. Initial treatment was observation in 227, embolization in 15, and splenectomy in 17. In the observation group, 9 (4%) of 227 children failed initial treatment; 8 of these underwent embolization, while 1 unerwent splenectomy. In the embolization group, 1 (7%) of 15 failed initial treatment and underwent splenectomy. Blood transfusion was required by 38 (17%) of 227 in the observation group, 6 (40%) of 15 (p = 0.02) in the embolization group, and 15 (88%) of 17 (p < 0.01) in the splenectomy group. Overall splenic salvage rate was 237 (92%) of 259. Three children died in the observation group, and four children died in the splenectomy group. There was no death in the embolization group.


CONCLUSIONS
Splenic artery embolization for blunt trauma in children is associated with a higher blood transfusion rate compared with observation but offers a safe, intermediate alternative to splenectomy when observation fails.


METHODS
Therapeutic study, level IV.
From the Departments of Surgery (J.L.G., N.L.W., C.A.H., R.J.S., A.P.K., C.P.C.), and Radiology (C.P.), Geisinger Medical Center, Danville, Pennsylvania.
Jessica L
JL
Gross
Nicole L
NL
Woll
Carol A
CA
Hanson
Christoph
C
Pohl
Ronald J
RJ
Scorpio
Alfred P
AP
Kennedy
Christopher P
CP
Coppola
D000293:Adolescent; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply / Q000293:injuries*; D013156:Splenectomy; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000293:injuries; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*