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Can time to Healing in Pediatric Blunt Splenic Injury be Predicted?
Catherine M. Dickinson MD1, Roberto J. Vidri MD1, Alexis D. Smith MD1,2, Hale E. Wills MD1,2, Francois I. Luks MD, PhD1,2. 1Alpert Medical School Brown University, Rhode Island Hospital, Providence, Rhode Island, USA, 2Hasbro Children's Hospital, Providence, Rhode Island, USA.

Background: Follow-up imaging for blunt splenic injury (BSI) in children is not routinely recommended, but advice regarding the time of return to contact sports varies widely among surgeons. We studied the natural evolution of blunt splenic injuries to identify patient populations at highest risk of delayed healing in order to assist in counseling patients on return to full activities.

Methods: We retrospectively reviewed all children with blunt splenic injuries at a Level 1 Trauma Center. Injury grade, and follow-up imaging results were analyzed. Spleens were classified as 'healed,' 'healing' or 'non-healing'.

Results: Between 2000 and 2014, 222 patients with BSI were identified. Eight underwent immediate splenectomy. Transfusion was required in 5.9% (2.1% of isolated BSI). One hundred fifty-one patients (71%) underwent follow-up imaging, up to 30 weeks post-injury. The ROC curve shows the relationship between sensitivity and specificity of capturing non-healing spleens over time. Maximum sensitivity and specificity was found at 7-8 weeks for grades I and II. No such trend was seen in higher-grade injuries (area under the curve ≈ 50%).

Conclusions: Most low-grade splenic injuries are healed by 7-8 weeks. The natural course of higher-grade injuries is not predictable, and return to contact sports may have to be individualized, and delayed until radiographic evidence of healing. Longer, multicenter prospective studies may identify healing patterns in these patients.

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