A retrospective examination of the management of pediatric blunt spleen and liver injuries

Abstract

Introduction: The American Pediatric Surgical Association (APSA) has published validated guidelines regarding non-operative management of pediatric blunt spleen and liver injuries (BSLI) based on injury grade. Although these guidelines exist, few studies have examined guideline implementation and adherence in a clinical setting. This study sought to examine current clinical treatment of BSLI and assess practitioner adherence to guidelines at a single pediatric tertiary care center. Methods: A retrospective review was performed of all pediatric patients (<18 years) in the local Trauma Registry who received non-operative management of BSLI between January 1^st 2004 and November 31^st 2014. Collected data included demographic information, guideline compliance and radiology grade reporting. Statistical analyses with chi-square tests were conducted to assess differences between spleen/liver injuries and organ injury grades. Results: Sixty-five (92%) abstracted cases were analyzed. Guideline compliance for intensive care unit (ICU) admission, length of hospitalization, pre-/post-discharge imaging and physical activity restriction was 29%, 21%, 75%, 75% and 40%, respectively. Radiologists reported injury grades in 22% of spleen cases and 15% of liver cases (p=0.46). Additionally, 8% of spleen and 33% of liver injuries (p=0.01) did not have a reported grade of organ injury. Discussion: At this center, a substantial number of BSLI cases had no reported grade, and APSA guideline adherence was low for ICU admission, activity restriction and length of hospitalization. In order to emphasize the importance of guideline compliance, future directions include the creation of clinician and patient educational handouts to increase adherence rates.