Follow-up abdominal computed tomography after splenic trauma in children may not be necessary

Nonoperative management of splenic injuries in children is well accepted. H owever, the need for follow-up abdominal CT to document splenic healing has not been well studied. We retrospectively reviewed initial and follow-up a bdominal CT examinations of pediatric patients admitted to our institution with documented splenic trauma who were managed nonoperatively. Eighty-four patients were admitted to our pediatric surgical service with splenic inju ry documented by CT from 1994 through 1998, The standard approach for splen ic injury was bedrest for 5 to 21 days and limited activity for up to 90 da ys at the discretion of the attending surgeon. Thirty-five of the 84 had fo llow-up CTs during outpatient follow-up to evaluate and document splenic he aling by CT criteria. The initial and follow-up studies were randomized and read blindly by pediatric radiologists using a modified American Associati on for the Surgery of Trauma grading system (I-V). The age range of the pat ients was 6 months to 17 years (mean +/- SE; 11 +/- 1 years). Nineteen (54% ) were male and 16 (46%) were female. Causes of splenic trauma included mot or vehicle accident (22), fall (seven), assault (four), pedestrian versus v ehicle (one), and sports injury (one). Eight children (23%) had grade II in juries, 14 (40%) had grade III injuries, and 13 children (37%) had grade IV injuries on initial CT scan. Seven (88%) of the grade II splenic injuries were healed by 64 +/- 11 days. The remaining grade II injury had healed by 210 days. Thirteen (93%) of the grade III splenic injuries were healed by 7 6 +/- 7 days. The remaining grade III injury was healed by 140 days. Spleen s in 10 (77%) of the 13 patients with grade IV injuries were healed by 81 /- 8 days, Of the three remaining grade TV injuries two were healed by 173 +/- 14 days. The remaining patient's spleen was radiologically considered t o have a grade III defect 91 days from the time of injury, and no further C Ts were obtained. Of the 34 patients who underwent follow-up CT imaging unt il splenic healing was demonstrated the mean time to complete healing was 8 7 +/- 8 days postinjury (range 11-217 days). These data suggest that routin e follow-up abdominal CTs may not be necessary to allow children to resume their normal activities after an appropriate time of restricted activity.