title: Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population.
abstract: BACKGROUND
  Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE.
  
  
  METHODS
  The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting.
  
  
  RESULTS
  Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) CONCLUSION: Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy.
authors: Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors: Kristy L
authors: KL
authors: Rialon
authors: Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors: Brian R
authors: BR
authors: Englum
authors: Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors: Brian C
authors: BC
authors: Gulack
authors: Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Carlos J
authors: CJ
authors: Guevara
authors: Division of Pediatric Surgery, Department of Surgery, Vanderbilt Children's Hospital, Nashville, TN, USA.
authors: Syamal D
authors: SD
authors: Bhattacharya
authors: Division of Trauma and Critical Care, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors: Mark L
authors: ML
authors: Shapiro
authors: Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, HAFS Building, Room 6680, Durham, NC 27710, USA.
authors: Henry E
authors: HE
authors: Rice
authors: Division of Trauma and Critical Care, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors: John E
authors: JE
authors: Scarborough
authors: Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, HAFS Building, Room 6680, Durham, NC 27710, USA. Electronic address: obinna.adibe@dm.duke.edu.
authors: Obinna O
authors: OO
authors: Adibe
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004621:Embolization, Therapeutic; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D011183:Postoperative Complications; D013154:Spleen / Q000293:injuries* / Q000601:surgery*; D013156:Splenectomy; D014481:United States / Q000453:epidemiology
keywords: Angioembolization; Pediatric trauma; Splenectomy; Splenic trauma