title: Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization.
abstract: BACKGROUND
  Splenic artery embolization (SAE) in the presence of contrast blush (CB) has been recommended to reduce the failure rate of nonoperative management. We hypothesized that the presence of CB on computed tomography has minimal impact on patient outcomes.
  
  
  METHODS
  A retrospective review was conducted of all children (<18 years) with blunt splenic trauma over a 10-year period at a level 1 pediatric trauma center. Data are presented as mean ± standard error of mean.
  
  
  RESULTS
  Seven hundred forty children sustained blunt abdominal trauma, of which 549 had an identified solid organ injury. Blunt splenic injury was diagnosed in 270 of the 740 patients. All patients were managed nonoperatively without SAE. CB was seen on computed tomography in 47 patients (17.4%). There were no significant differences in the need for blood transfusion (12.5% vs 11.1%) or length of stay (3.1 vs 3.3 days) or need for splenectomy when compared in children with or without CB.
  
  
  CONCLUSIONS
  Pediatric trauma patients with blunt splenic injuries can be safely managed without SAE and physiologic response and hemodynamic stability should be the primary determinants of appropriate management.
authors.affiliation: Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, St Louis, MO 63104, USA.
authors.forename: Samiksha
authors.initials: S
authors.lastname: Bansal
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Karrer
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Hansen
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA. Electronic address: david.partrick@childrenscolorado.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
mesh_terms: D000792:Angiography / Q000706:statistics & numerical data; D002648:Child; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy*
keywords: Angiographic embolization; Contrast blush; Pediatric; Splenic trauma