title: Pediatric Splenic Injury: Nonoperative Management First!
abstract: OBJECTIVE
  In the past splenectomy was the standard procedure for traumatic blunt splenic injury, when bleeding of the spleen occurred. Since the spleen performs important immunological functions the advantage of a spleen-saving approach is preservation of immunological functions. Especially in the pediatric population splenic preservation is an important objective. Spleen-saving treatment, in particular selective nonoperative management, has gained ground in the past 20 years. An 18-year retrospective review was performed to evaluate our cumulative experience with nonoperative management.
  
  
  METHODS
  hemodynamical instability and splenectomy.
  
  
  METHODS
  Forty-six patients were identified. Demographics, methods of management, mechanism of injury, injury grade, associated injuries, hemodynamical parameters, bloodtransfusion, complications, ICU and hospital stay were documented and analyzed to determine statistical significance between modes of management.
  
  
  RESULTS
  Initially, 34 patients were managed nonoperatively, while 12 patients underwent laparotomy - with 7 (58.3% of the operative group) of these having splenectomy performed. Three patients (out of 34) failed nonoperative management and required delayed splenorraphy or splenectomy, a 91.2% (3 out of 34 failed) success rate for intended nonoperative management versus 85.7% for intended splenorraphy (1 out of 7 failed). Thus, overall rates of 67.4% nonoperative management and 82.6% splenic conservation were achieved. Analysis of parameters between treatments showed significant differences between nonoperative management and splenorraphy for splenic injury grade II and IV.
  
  
  CONCLUSIONS
  We recommend based on our data on children with splenic injury grades II and IV that the standard treatment for children aged 0 to 18 years due to blunt abdominal trauma should be nonoperative management. However management of blunt splenic injury remains a clinical decision, for this reason does not preclude on CT-scan grade V for nonoperative management.
authors.affiliation: Department of Surgery, Section of Traumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hugo T C
authors.initials: HT
authors.lastname: Veger
authors.affiliation: Department of Traumatology, VU University Medical Center, Amsterdam, The Netherlands. g.jukema@vumc.nl.|Department of Traumatology, VU University Medical Center, 7057, 1007 MB, Amsterdam, The Netherlands. g.jukema@vumc.nl.
authors.forename: Gerrolt N
authors.initials: GN
authors.lastname: Jukema
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Bode
keywords: Nonoperative management; Pediatric blunt splenic injury; Splenic injury