title: Twenty-years of splenic preservation at a level 1 pediatric trauma center.
abstract: BACKGROUND
  Splenic preservation is the standard of care for hemodynamically stable children with splenic injuries. We report a 20-year single-institutional series of children with splenic injuries managed without a splenectomy.
  
  
  METHODS
  Children evaluated and treated for blunt splenic injury at Boston Children's Hospital from 1994 to 2014 were extracted from the trauma registry. Demographics, clinical characteristics, complications, and outcomes were reviewed. Three time-periods were evaluated based upon the development and modification of splenic injury clinical pathway guidelines (CPGs). Survival was defined as being discharged from the hospital alive.
  
  
  RESULTS
  502 suffered isolated splenic injuries. The median AAST grade of splenic injury increased across the three CPG time periods (p<0.001). No splenic-injury related mortalities occurred. Hospital length of stay decreased significantly secondary to splenic injury CPGs (p<0.001). 99% of the patients were discharged home.
  
  
  CONCLUSIONS
  In children managed over the last 20years for isolated splenic injury, no patient died or underwent splenectomy. Hospital length of stay decreased across time, despite an increase in the severity of splenic injuries encountered. Splenectomy has become so unusual in the management of hemodynamically stable children with a splenic injury that it may no longer be a legitimate outcome marker.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA. Electronic address: sigrid.bairdain@childrens.harvard.edu.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Litman
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Troy
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: McMahon
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Almodovar
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Mooney
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000601:surgery*
keywords: Clinical practice guidelines (CPGs); Length of stay (LOS); Mortality; Non-operative management; Outcome; Pediatric trauma; Splenic injury