COMPUTED-TOMOGRAPHY GRADE OF SPLENIC INJURY IS PREDICTIVE OF THE TIMEREQUIRED FOR RADIOGRAPHIC HEALING

It is largely unknown when a child who has suffered a splenic lacerati on can return to full unrestricted activity. The purpose of this prosp ective study is to establish whether the grade of splenic injury is pr edictive of the length of time required for radiographic healing, and to determine whether there are any adverse long-term sequelae after re sumption of unlimited activity. Sixty-nine patients underwent successf ul nonoperative management (NOM) of computed tomography (CT)-documente d splenic injury over a 4-year period. Fifty-eight patients completed follow-up. Mean age was 9.8 years (range, 1 to 17) and mean injury sev erity score (ISS) was 14.4 (range, 4 to 38). Mechanisms of injury were motor vehicle accident (n = 11), motor vehicle pedestrian (n = 5), fa lls (n = 13), bike crashes (n = 12), sports (n = 8), ail-terrain vehic le (n = 4), and horse (n = 5). The CT-documented injury was identified by discharge ultrasound scan (US) in all cases. There were no long-te rm complications. Mean time to US healing in grade I (n = 9), II (n = 26), III (n = 19), IV (n = 4) injuries was 3.1, 8.2, 12.1, and 20.7 we eks, respectively. P values were significant (P <.01) in all cases whe n compared with the next lower injury grade. The time to radiographic healing is directly proportional to the severity of the splenic injury . There was excellent correlation between the initial CT scan and iden tification of the injury on the discharge US. No long-term complicatio ns leg, delayed splenic rupture, splenic pseudocyst) were seen in this study. Pediatric patients who have suffered splenic injury can safely return to full unrestricted activity when the US documents healing. C opyright (C) 1997 by W.B. Saunders Company.