Associated factors to non-operative management failure of hepatic and splenic lesions secondary to blunt abdominal trauma in children

Abstract

Introduction: The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients. Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma

Patients and Method: Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and / or closed Spleen.

Results: 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) < 90 mmHg at admission (p=0.0126; RR=5.19), drop in hemoglobin (Hb) > 2 g/dl in the first 24 hours (p=0.0009; RR=15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR=17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM.

Conclusions: Children with blunted hepatic or splenic trauma  respond to NOM. Factors such as BP < 90 mmHg at admission, an Hb fall > 2 g/dl in the first 24 hours, and transfusion of 3 or more units of RBC were associated with the failure in NOM.