Management of blunt splenic injury in children: evolution of the nonoperative approach
Section snippets
Methods
The Research Ethics Board of The Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, granted ethics approval for this study (REB#1000011509). The medical records of all children (younger than 16 years) admitted with documented BSI between January 1, 1992, and December 31, 2006 (14 years), were examined. The Trauma Registry at our level 1 pediatric trauma center was used to collect demographic data (age, weight, and sex,) and injury-specific data (length of stay and Injury
Results
The populations and demographic characteristics of each era are summarized in Table 1. Each era had a significant number of isolated blunt splenic injuries, defined as those occurring in children with no other major torso, head, spine, or extremity injuries. The mean age and proportional sex distribution of patients were similar throughout the 4 eras.
We present the data for each era as both the overall cohort of blunt splenic injuries and those occurring in isolation. Not only has the
Discussion
The management of blunt splenic injuries in children almost universally consisted of splenectomy until the 1960s. In the early 1900s, proponents of operative management cited delayed bleeding, splenic pseudocyst, organizing hematoma, and abdominal splenosis as the possible consequences of nonoperative management [6], [7], [8], [9]. Various surgeons observed that most of the splenic injuries they operated on had stopped bleeding by the time a laparotomy was performed [1], [10]. This was observed
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Cited by (0)
Presented at the 40th Annual CAPS Meeting, August 21-24, 2008, Toronto, Ontario, Canada.