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Is successful non-operative management of isolated pediatric splenic trauma in children possible in an Indian urban hospital.

Background: Non-operative management in majority of paediatric blunt abdominal trauma injuries is routine. The need for pediatric intensive care unit (PICU) admission, length of hospital stay pre and post discharge imaging, duration of activity restriction varies from country to country and center to centre. The purpose of this study was to characterize the pattern of practice in a developing state health institution and formulate safe and effective care plan for managing children with isolated blunt splenic injuries. Method: A retrospective study between 2009-2015 with isolated blunt splenic trauma at our hospital in paediatric population. Result: A total of 40 children (30 male and 10 female) with isolated blunt trauma spleen were included in this study. Age group was between 2.5–16 years (mean 9.5 ± 0.17 years). Fifteen patients were hemodynamically unstable and were resuscitated at reception. Average grade of splenic injury was 2.9. All the patients were admitted in general ward and attached to monitor with heart rate (HR), respiratory rate(RR),electrocardiogram (ECG), blood pressure (B.P) and oxygen saturation (SPO2) monitoring. Average length of hospital stay was 5.5 days (Range 3-11 days). Initial imaging was Ultrasonography (USG) and contrast enhanced computed tomography (CECT) in 18 patients and CECT abdomen only 22 patients. Follow-up imaging was done with USG only in 10 patients (25%) before discharge. Mean observed activity restriction in our study was 5 weeks range (4-8 weeks). All the 40 patients had successful non-operative management without any death or complication. Conclusion; Non-operative management of isolated blunt splenic trauma in paediatric patients was 100% successful in our study. Routine pre-discharge imaging may not be necessary and admission to paediatric ICU might not be mandatory, provided strict hemodynamic monitoring is done. In most isolated splenic injuries 6 weeks activity restriction is safe.

Author(s): Raashid Hamid