Update of nonoperative management of blunt spleen and/or liver injuries in pediatric patients
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Date
2017
Authors
Gregoire, Mychele
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Abstract
Since its publication in 2000, the American Pediatric Surgical Association guidelines has been used to manage hemodynamically stable patients with blunt solid organ injuries. CT injury grade is used to guide ICU stay, overall length of hospital stay, activity restriction and pre-and post-discharge imaging. After publication, there has been growing evidence that these guidelines are too conservative. The purpose of this study is to review the current literature regarding non-operative management of liver and spleen injuries in children, and to review the management of children with spleen and/or liver injuries admitted to the Children’s Hospital at the Health Sciences Centre in the past 5 years. Injury severity score, bed rest, oral intake, blood draws, blood transfusion, length of hospital stay, activity restriction and imaging were recorded. Forty-eight cases were included, 29 splenic injuries, 18 liver injuries and 1 case with both. Two cases failed non-operative management. Current literature provides ample evidence that an abbreviated management protocol based on hemodynamic stability rather than CT grade shortens hospital stay but does not compromise patient safety. The chart review demonstrated that all children who were admitted were safely discharged home; however, variations of management and resource utilization were observed. It is proposed that an abbreviated protocol based on hemodynamic parameters will decrease hospital stay, reduce hospital costs, increase patient satisfaction but remain safe.
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Keywords
Liver, Spleen, Blunt trauma, Pediatrics, Nonoperative management