title: Pleural effusion following blunt splenic injury in the pediatric trauma population.
abstract: BACKGROUND
  Pleural effusion is a potential complication following blunt splenic injury. The incidence, risk factors, and clinical management are not well described in children.
  
  
  METHODS
  Ten-year retrospective review (January 2000-December 2010) of an institutional pediatric trauma registry identified 318 children with blunt splenic injury.
  
  
  RESULTS
  Of 274 evaluable nonoperatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided pleural effusions. Seven (58%) of 12 patients required left-sided tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time from injury to diagnosis of pleural effusion was 1.5days. Median time from diagnosis to tube thoracostomy was 2days. Median length of stay was 4days for those without and 7.5days for those with pleural effusions (p<0.001) and 6 and 8days for those pleural effusions managed medically or with tube thoracostomy (p=0.006), respectively. In multivariate analysis, high-grade splenic injury (IV-V) (OR 16.5, p=0.001) was associated with higher odds of developing a pleural effusion compared to low-grade splenic injury (I-III).
  
  
  CONCLUSIONS
  Pleural effusion following pediatric blunt splenic injury has an incidence of 4.4% and is associated with high-grade splenic injuries and longer lengths of stay. While some symptomatic patients may be successfully managed medically, many require tube thoracostomy for progressive respiratory symptoms.
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, USA; Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Engbrecht
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Pinzon-Guzman
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Vance L
authors.initials: VL
authors.lastname: Albaugh
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Rzucidlo
authors.affiliation: Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.affiliation: Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, USA. Electronic address: rcilley@hmc.psu.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Cilley
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009104:Multiple Trauma / Q000150:complications; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013906:Thoracoscopy; D014949:Wounds, Nonpenetrating / Q000150:complications*
keywords: Blunt splenic injury; Nonoperative management; Pediatric trauma; Pleural effusion; Splenic laceration