NONOPERATIVE MANAGEMENT OF BLUNT HEPATIC AND SPLENIC INJURY IN CHILDREN

Objective The authors assessed the risks of nonoperative management of solid visceral injuries in children (age range, 4 months-14 years) wh o were consecutively admitted to a level I pediatric trauma center dur ing a 6-year period ending in 1991. Method One hundred seventy-nine ch ildren (5.0%) sustained injury to the liver or spleen. Nineteen childr en (11.2%) died. Of the 160 children who survived, 4 received emergenc y laparotomies; 156 underwent diagnostic computer tomography and were managed nonoperatively. The percentage of children who were successful ly treated nonoperatively was 97.4%. Delayed diagnosis of enteric perf orations occurred in two children. Fifty-three children (34.0%) receiv ed transfusions (mean volume 16.7 mL/kg); however, transfusion rates d uring the latter half of the study decreased from 50% to 19% in childr en with hepatic injuries, despite increasing grade of injury, and decr eased from 57% to 23% in the splenic group with similar injury grade ( p < 0.005, chi square test and Student's t test). Conclusion Pediatric blunt hepatic and splenic trauma is associated with significant morta lity. Nonoperative management based on physiologic parameters, rather than on computed tomography grading of organ injury, was highly succes sful, with few missed injuries and a low transfusion rate.