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The Spleen Not Taken: Differences in Management and Outcomes of Blunt Splenic Injuries in Teenagers Cared For by Adult and Pediatric Trauma Teams in a Single Institution
Kristen Zeller MD, FACS, FAAP, Sean O'Connor, MD, Leah Sieren, MC, FACS, FAAP and Andrea Doud, MD, Wake Forest School of Medicine, Winston-Salem NC

Background: Non-operative management (NOM) of blunt splenic injury, initially touted for the care of pediatric patients, has become the standard of care for stable trauma patients of all ages. In our institution, trauma patients <16 years old are managed by the pediatric surgery service and patients ≥16 years are managed by the adult trauma service. Angioembolization is routinely employed for adults with blunt splenic injury but rarely used for pediatric patients. A retrospective chart review was performed to determine if more liberal use of angioembolization increases the success rate of NOM of blunt splenic injury in adolescents. Methods: Using our institutional trauma registry, we performed a retrospective chart review of 15 and 16 year olds admitted with blunt splenic injury from 2007-2015. 49 patients were identified; 23 “pediatric” 15 year olds and 26 “adult” 16 year olds. The cohorts were compared with respect to imaging performed, grade of injury, ISS scores, presence of active extravasation or pseudoaneurysm, interventions performed, blood transfused, ICU days, length of stay, complications, and 30-day mortality rates were analyzed. Results: There were no significant differences in ISS scores, incidence of active extravasation or pseudoaneurysm, or grade of injury between the two cohorts. More patients underwent angioembolization in the ”adult” group (P .0013) with no difference in the success rate of NOM (P .333). Conclusion: Aggressive use of angioembolization does not improve the success rate of NOM in adolescents. True “non-interventional management” is safe and effective for hemodynamically stable children despite the severity of splenic injury.

Objective: At the end of this activity, the learner will be able to discuss the indications for splenic angioembolization in pediatric blunt trauma patients.

Objective Content: Our data shows no association between IR intervention and improved failure rates of non-operative management in adolescent trauma patients."

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