Can time to healing in pediatric blunt splenic injury be predicted?
Current consensus guidelines do not recommend routine follow-up imaging for blunt splenic injury (BSI) in children. However, repeat imaging is recommended based on persistent symptoms. Wide variation of practice continues to exist among surgeons. By defining the natural evolution of BSI, we sought to identify patients at higher risk for delayed healing who could benefit from outpatient imaging.
A retrospective review of all children with BSI at a Level 1 Pediatric Trauma Center was completed. Grade of injury, hospital course, laboratory values and follow-up imaging results were obtained. Injured spleens were classified as ‘healed’, ‘healing’ (with echogenic scar), or ‘non-healing’ with persistence of parenchymal abnormalities.
Between 2000 and 2014, 222 patients with BSI were identified. Seven patients (3%) underwent immediate splenectomy. Packed red blood cell transfusion was required in 13 (6%) of the 222 patients, and 3 (2%) of 145 with isolated splenic injuries. Seventy-one percent of patients underwent additional imaging 2–74 weeks post-injury. A receiver operating characteristics (ROC) curve was used to establish the relationship between sensitivity and specificity of capturing non-healing spleens over time. Optimal timing for post-injury imaging for grades I–II was 7–8 weeks; healing of higher-grade injuries could not accurately be predicted.
If return to full physical activity, in particular contact sports, is contingent upon documented healing of the splenic parenchyma after blunt trauma in the pediatric population, follow-up imaging for low-grade injuries is best obtained around 7–8 weeks. No such recommendations can be made for high-grade splenic injuries, as the exact time to healing cannot be predicted based on initial data.
Level of evidence
IV. Diagnostic test.
KeywordsPediatric trauma Blunt splenic injury Imaging
Catherine M. Dickinson, MD participated in the literature search, study design, data collection, data analysis, data interpretation, writing, and critical revision of this manuscript. Roberto J. Vidri, MD participated in the literature search, study design, data collection, data analysis, data interpretation, writing, and critical revision of this manuscript. Alexis D. Smith, MD participated in the literature search, data interpretation, writing, and critical revision of this manuscript. Hale E. Wills, MD participated in the data interpretation, writing, and critical revision of this manuscript. Francois I. Luks, MD, PhD participated in the study design, data analysis, data interpretation, writing, and critical revision of this manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare they have no conflicts of interest.
We have no financial disclosures.
- 3.Notrica DM, Eubanks JW III, Tuggle DW, Maxson RT, Letton RW, Garcia NM, Alder AC, Lawson KA, St Peter SD, Megison S, Garcia-Filion P (2015) Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg 79(4):683–693CrossRefGoogle Scholar
- 5.Stylianos S, Egorova N, Guice KS, Arons RR, Oldham KT (2006) Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers: a call for dissemination of American Pediatric Surgical Association benchmarks and guidelines. J Am Coll Surg 202(2):247–251CrossRefGoogle Scholar
- 9.Leschied JR, Mazza MB, Davenport MS, Chong ST, Smith EA, Hoff CN, Ladino-Torres MF, Khalatbari S, Ehrlich PF, Dillman JR (2016) Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline. Pediatr Radiol 46(2):229–236CrossRefGoogle Scholar