MANAGEMENT OF BLUNT SPLENIC TRAUMA - SIGNIFICANT DIFFERENCES BETWEEN ADULTS AND CHILDREN

Background. Although highly successful in children, nonoperative manag ement of blunt splenic injury in adults is less defined. The purpose o f this study was to determine whether mechanism of injury, grade of sp lenic injury, associated injuries, and pattern of injury differ betwee n adults and children (younger than 15 years of age). Methods. Four hu ndred eleven patients (293 adults and 118 pediatric patients) with blu nt splenic injury were admitted to an affiliated adult/pediatric traum a program from 1989 to 1994. Computed tomography (CT) scans were inter preted in a blinded fashion. Mechanism of injury was significantly dif ferent for adults versus children (p < 0.05): motor vehicle crash (66. 9% versus 23.7%), motorcycle (8.8% versus 0.8%), sports (2.4% versus 1 6.9%), falls (8.8% versus 25.4%), pedestrian/automobile (4.4% versus 1 1.0%), bicycle (1.4% versus 9.3%), and other (7.3% versus 12.7%). Resu lts. Higher injury severity scores, lower Glasgow Coma Scales, and hig her mortality indicated that the adults were more severely injured tha n the children. Fifty-nine percent of tile adults and 7% of the childr en required immediate laparotomy for splenic injury. Both CT grade and quantity of blood on CT predicted the need for exploration in adults but not in children. An injury severity score above 15 and high-energy mechanisms correlated with the need for operative intervention. Concl usions. Rather than children simply being physically different, they a re injured differently than adults, hence the high rate of nonoperativ e management.