Nonoperative management of splenic and hepatic trauma in the multiply injured pediatric and adolescent patient
M. C. Coburn, J. Pfeifer and F. G. DeLuca
Department of Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence.
OBJECTIVE: To determine whether nonoperative management of splenic and
hepatic injury in the multiply injured pediatric and adolescent patient is
both safe and efficacious. DESIGN: Retrospective case series. SETTING:
Level 1 trauma center. PATIENTS: All patients younger than 19 years old who
suffered trauma to the spleen or liver between February 1978 and December
1991 (n = 103) were retrospectively identified by a trauma registry. These
patients were divided into three groups: the group as a whole, those
suffering multiple injuries, and those suffering either head injury or
injury remote from the abdomen that required operative repair. MAIN OUTCOME
MEASURES: Injury severity and outcome within each group of patients were
compared based on whether the splenic or hepatic injury was managed
operatively or nonoperatively. RESULTS: Mean Injury Severity Scores among
the multiply injured patients were not different depending on whether the
splenic or hepatic injury was managed nonoperatively or operatively. Except
for a higher incidence of transfusion requirement among patients who were
treated operatively, measures of morbidity among the multiply injured
patients did not differ based on treatment. The success rates of
nonoperative treatment among all patients, those with multiple injuries,
and those with either head injury or remote injury that required surgery
were 94%, 90%, and 86%, respectively. CONCLUSION: Nonoperative management
of splenic and hepatic injury in multiply injured pediatric and adolescent
patients, including those with head injury and injury remote from the
abdomen that requires surgical intervention, is successful and is not
associated with a prohibitive morbidity.
