Management of pediatric splenic trauma

BACKGROUND: In this study, we aimed to present the management and treatment processes of patients with splenic trauma, discuss nonoperative treatment approaches, and share our institutional experience.
METHODS: A total of 244 patients hospitalized for splenic trauma between January 2010 and January 2020 were retrospectively analyzed.
RESULTS: Splenic injury was present in 22% of trauma patients who presented to the emergency department and were consulted by pediatric surgery. The most common cause of splenic injury was falls (60%). Forty-three percent of patients were of school age. Ninety percent of patients had Grade I-III splenic injuries. The mean age at presentation was 7.90 years. The mean hematocrit level was 32% and the mean hemoglobin level was 10.90. Blood transfusion was administered to 29% of patients. Additional injuries were present in 45.9% of cases, with the lung being the most frequently affected organ. The mean length of hospital stay was 6.03 days. Mortality occurred in five patients, and morbidity was observed in five patients. There was a statistically significant correlation between blood pressure, urine output, and mortality. A statistically significant association was also found between platelet-to-lymphocyte ratio, blood transfusion, hemoglobin level, Glasgow Coma Scale (GCS) score, and mortality (p<0.001). Furthermore, significant correlations were identified between GCS score, length of hospital stay, neutrophil count, and the presence of additional injuries (p<0.001). A strong negative correlation was observed between lactate levels and blood transfusion (r=-0.610), as well as between lactate levels and GCS score (r=-0.645). In the ROC analysis evaluating lactate as a predictor of additional injury, a sensitivity of 58% and specificity of 83% were identified at a cutoff value of 1.9.
CONCLUSION: We recommend nonoperative management for patients with splenic injury, as it reduces mortality, morbidity, and healthcare costs. Treatment protocols for these patients should be scientifically standardized.

Keywords: spleen trauma in children, nonoperative treatment, pediatric trauma

Çocuklarda dalak travmalarýnýn yönetimi

AMAÇ: Dalak travmalý hastalarýn yönetim ve tedavi süreçlerini sunmayý, nonoperatif tedavi yönetimini tartýþmayý ve deneyimlerimizi paylaþmayý amaçlýyoruz.
GEREÇ VE YÖNTEM: Ocak 2010 ile Aralýk 2019 tarihleri arasýnda dalak travmasý nedeniyle hastaneye yatýrýlan 244 hasta çalýþmaya dahil edildi ve retrospektif olarak analiz edildi.
BULGULAR: Acil servise baþvuran ve çocuk cerrahisi ile konsülte edilen travma hastalarýnýn %22'sinde dalak yaralanmasý mevcuttu. Dalak ya-ralanmasýnýn en sýk nedeni düþme (%60) idi. Hastalarýn %43'ü okul çaðýndaydý. Hastalarýn %90'ýnda evre 1-2-3 dalak yaralanmasý vardý. Baþvuru anýnda ortalama yaþ 7.90, ortalama hematokrit 32, ortalama hemoglobin 10,90 idi. Hastalarýn %29'una transfüzyon yapýldý. Hastalarýn %45.9'unda ek yaralanma vardý ve en sýk yaralanan organ akciðerdi. Ortalama hastanede kalýþ süresi 6,03 gündü. 5 hastada mortalite, 5 hastada ise morbidite görüldü. Kan basýncý ve idrar çýkýþý ile mortalite arasýnda istatistiksel olarak anlamlý bir iliþki vardý. (p<0.05) Trombosit/lenfosit oraný, kan transfüz-yonu, hemoglobin ve GCS ile mortalite arasýnda istatistiksel olarak anlamlý bir iliþki bulundu. (p<0.001) GCS, hastanede kalýþ süresi, nötrofil sayýsý ve ek yaralanma arasýnda istatistiksel olarak anlamlý iliþki bulundu. (p<0.001) Laktat ve kan transfüzyonu ile GKS arasýnda yüksek düzeyde negatif korelasyon olduðu görüldü. (sýrasýyla r=-0,610 ve r=-0,645) Laktat ile ek yaralanma için yapýlan ROC analizinde laktat cut off deðeri 1,9'da duyarlýlýk %58, özgüllük %83 olarak belirlendi.
SONUÇ: Dalak yaralanmalý hastalara ameliyatsýz tedaviyi hem mortaliteyi, hem morbiditeyi hem de maliyeti azalttýðý için öneriyoruz. Hastalarýn tedavi yönetimi bilimsel olarak standardize edilmelidir.

Anahtar Kelimeler: çocuklarda dalak travmalarý, nonoperatif tedavi, pediatrik travma