Abstract
The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P=0.002 by χ2-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P=0.41 by χ2-test) or amount (P=0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury.
Similar content being viewed by others
References
Federle MP (1983) Computed tomography of blunt abdominal trauma. Radiol Clin North Am 21: 461–475
Moon KL, Federle MP (1983) Computed tomography in hepatic trauma. AJR 141: 309–314
Federle MP (1987) Splenic trauma: evaluation with CT. Radiology 165: 643–646
Berger PE, Kuhn JP (1981) CT of blunt abdominal trauma in childhood. AJR 136: 105–110
Kaufman RA, Towbin R, Babcock DS, et al (1984) Upper abdominal trauma in children: imaging evaluation. AJR 142: 449–460
Karp MP, Cooney DR, Pros GA, Newman BM, Jewett TL (1983) The nonoperative management of pediatric hepatic trauma. J Pediatr Surg 18: 512–519
Oldham KT, Guice KS, Ryckman F, et al (1986) Blunt liver injury in childhood: evolution of therapy and current perspective. Surgery 100: 542–549
Brick SH, Taylor GA, Potter BM, Eichelberger MR (1987) Hepatic and splenic injury in children: role of CT in the decision for laparotomy. Radiology 165: 643–646
Taylor GA, Fallat ME, Potter BM, Eichelberger MR (1988) The role of comoputed tomography in blunt abdominal trauma in children. J Trauma 28: 1660–1664
Trauma Committee, Canadian Association of Paediatric Surgeons (1989) Canadian Association of Paediatric Surgeons: liver trauma study. J Paediatr Surg 24: 1035–1044
Galat JA, Grisoni ER, Gauderer WL (1990) Pediatric blunt liver injury: establishment of criteria for appropriate management. J Pediatr Surg 25: 1162–1165
Lynch JM, Ford H, Gardner MJ, Weiner ES (1993) Is early discharge following isolated splenic injury in the hemodynamically stable child possible? J Pediatr Surg 28: 1403–1407
Berman SS, Mooney EK, Weireter LJ (1992) Late fatal hemorrhage in pediatric liver trauma. J Pediatr Surg 27: 1546–1548
McGillivray DC, Valentine RJ (1989) Nonoperative management of blunt pediatric liver injury-late complications: case report. J Trauma 29: 251–254
Feliciano PD, Mullins RJ, Trunkey DD, et al (1992) A decision analysis of traumatic splenic injuries. J Trauma 33: 340–347
Luna GK, Dellinger EP (1987) Nonoperative observation therapy for splenic injuries: a safe therapeutic option? Am J Surg 153: 462–468
Malangoni MA, Cue JI, Fallat ME, Willing SJ, Richardson JD (1990) Evaluation of splenic injury by computed tomography and its impact on treatment. Ann Surg 211: 592–597
Federle MP, Jeffrey RB (1983) Hemoperitoneum studied by computed tomography. Radiology 148: 187–192
Scorpio RJ, Wesson DE (1993) Splenic trauma. In: Eichelberger MR (ed) Pediatric Trauma. Mosby, St. Louis, pp 456–463
Ford HR, Gardner MJ, Meza MP, Wiener EP, Lynch JM (1993) Nonoperative management of splenic injuries in children without blood transfusion. (abstract) J Pediatr Surg 28: 568
Stylianos S, Wooton SL, Lund DP, Hendren WH (1993) Treatment of spleen and liver injuries in children without operation or transfusion. (abstract) J Pediatr Surg 28: 569
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ruess, L., Sivit, C.J., Eichelberger, M.R. et al. Blunt hepatic and splenic trauma in children: Correlation of a CT injury severity scale with clinical outcome. Pediatr Radiol 25, 321–325 (1995). https://doi.org/10.1007/BF02021691
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02021691