Management of blunt splenic injury in children: evolution of the nonoperative approach

Background: Nonoperative management of blunt splenic injury (BSI) was first proposed at our institution in 1948. Since that time, treatment of patients with BSI has evolved from routine splenectomy to an aggressive spleen-preserving philosophy. This report summarizes our institutional experience for the last 50 years. Methods: All children (0-18 years) admitted to our pediatric trauma center with BSI during 4 ears (1956-1965, 1972-1977, 1981-1986, and 1992-2006) were retrospectively reviewed for demographics. injury patterns, management, and complications. Results: During the 4 ears captured for the last 5 decades, 486 children experienced BSI. The mean age was 10 years with 347 males (71%). Nonoperative management rate increased from 42% to 97% with improvement in splenic salvage rate (42%-99%). Mean length of stay decreased from 17 to 5 days. In patients with isolated splenic injuries (50%), nonoperative management rate increased (36%-100%) and fewer received transfusions (60%-1%). Overall mortality rate improved (19%-6.6%, 8%-0.7% in isolated injuries). Conclusion: The management of BSI in children has changed dramatically for the last 50 years. This study clearly demonstrates the safety of nonoperative management and documents progressively lower rates of splenectomy and transfusion, shorter hospitalization, and an extremely low risk of mortality. (C) 2009 Elsevier Inc. All rights reserved.