Changes in the management of pediatric blunt splenic and hepatic injuries.

Background/purpose: Intensive care monitoring, blood replacement, and nonoperative treatment of splenic and hepatic injuries in stable patients is the standard practice in pediatric surgery with a success rate of 90% in children's trauma centers.

Methods: During the past 5 years, 55 children under 14 years of age have been treated for laceration of spleen, liver, or both, proven by computed tomography.

Results: In 34 (62%), other injuries were identified, and only 21 (38%) presented with isolated injuries. In the 21 children who had isolated injuries, 18 had laceration of spleen, two had liver lacerations, and one had liver and spleen laceration. One patient who had spleen laceration required laparotomy and splenorrhaphy because of hemodynamic instability 4 hours after admission. The other 20 patients were initially closely monitored indiscriminately in the Intensive Care Unit of the pediatric surgical nursing unit. Blood transfusion was given to four children during the first 24 hours of admission despite the fact that, retrospectively, all were hemodynamically stable. There was no morbidity or mortality in all the 55 children.

Conclusions: The results of this study suggest that intensive care monitoring is not mandatory in hemodynamically stable patients who have isolated liver or spleen injuries. Blood replacement should be indicated in patients who have hematocrit levels lower than 20% and signs of continuing blood loss. Because of structural characteristics of the young liver and spleen, early progressive mobilization can be indicated.