NONOPERATIVE MANAGEMENT OF SPLENIC AND HEPATIC-TRAUMA IN THE MULTIPLYINJURED PEDIATRIC AND ADOLESCENT PATIENT

Objective: To determine whether nonoperative manage ment of splenic an d hepatic injury in the multiply injured pediatric and adolescent pati ent is both safe and efficacious. Design: Retrospective case series. S etting: 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 tr auma registry. These patients were divided into three groups: the grou p as a whole, those suffering multiple injuries, and those suffering e ither head injury or injury remote from the abdomen that required oper ative repair. Main Outcome Measures: Injury severity and outcome withi n each group of patients were compared based on whether the splenic or hepatic injury was managed operatively or nonoperatively. Results: Me an Injury Severity Scores among the multiply injured patients were not different depending on whether the splenic or hepatic injury was mana ged nonoperatively or operatively, Except for a higher incidence of tr ansfusion requirement among patients who were treated operatively, mea sures 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 hepa tic injury in multiply injured pediatric and adolescent patients, incl uding those with head injury and injury remote from the abdomen that r equires surgical intervention, is successful and is not associated wit h a prohibitive morbidity.