Natural history of nonoperative management for grade 4 and 5 liver and spleen injuries in children

• Published in: Journal of pediatric surgery Vol. 43; no. 12; pp. 2264 - 2267
• Main Authors: Yang, Jeannie C, Sharp, Susan W, Ostlie, Daniel J, Holcomb, George W, St. Peter, Shawn D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2008
• Subjects: Accidents; Bed Rest; Biliary Tract Diseases - etiology; Biliary Tract Diseases - surgery; Blood Transfusion; Blunt abdominal trauma; Child; Child Abuse; Child, Preschool; Craniocerebral Trauma - mortality; Follow-Up Studies; Humans; Length of Stay; Liver; Liver - injuries; Multiple Trauma - mortality; Multiple Trauma - therapy; Nonoperative trauma; Organ Specificity; Pancreatitis - etiology; Pediatric trauma; Pediatrics; Pleural Effusion - etiology; Pleural Effusion - surgery; Radiography; Retrospective Studies; Spleen; Spleen - injuries; Surgery; Trauma Severity Indices; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy; Spleen; Pediatric trauma; Blunt abdominal trauma; Nonoperative trauma; Liver
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2008.08.059

Abstract Purpose Nonoperative management is standard treatment of blunt liver or spleen injuries. However, there are few reports outlining the natural history and outcomes of severe blunt hepatic and splenic trauma. Therefore, we reviewed our experience with nonoperative management of grade 4 or 5 liver and spleen injuries. Methods A retrospective analysis was performed on patients with grade 4 or 5 (high-grade) blunt liver and/or spleen injuries from April 1997 to July 2007 at our children's hospital. Demographics, hospital course data, and follow-up data were analyzed. Results There were 74 high-grade injuries in 72 patients. There were 30 high-grade liver and 44 high-grade spleen injuries. Two patients had both a liver and splenic injury. High-grade liver injuries had a significantly longer length of intensive care and hospital stay compared to high-grade spleen injuries. There were also a significantly higher number of transfusions, radiographs, and total charges in the high-grade liver injuries when compared to the high-grade splenic injuries. The only mortality from solid organ injury was a grade 4 liver injury with portal vein disruption. In contrast, there was only one complication from a high-grade splenic injury—a pleural effusion treated with thoracentesis. There were 5 patients with complications from their liver injury requiring 18 therapeutic procedures. Three patients (10%) with liver injury required readmission as follows: one 5 times, one 3 times, and another one time. Conclusions Patients with high-grade liver injuries have a longer recovery, more complications, and greater use of resources than in patients with similar injuries to the spleen.