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Pediatric blunt splenic trauma: a comprehensive review

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Abstract

Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, MI, USA

    Karen N. Lynn, Gabriel M. Werder, Rachel M. Callaghan, Zafar H. Jafri & David A. Bloom

  2. St. George’s University School of Medicine, Grenada, West Indies

    Ashley N. Sullivan

  3. Section of Pediatric Radiology, Department of Radiology, William Beaumont Hospital, 3601 West Thirteen Mile Rd., Royal Oak, MI, 48073-6769, USA

    David A. Bloom

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  1. Karen N. Lynn
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  2. Gabriel M. Werder
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  3. Rachel M. Callaghan
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Correspondence to David A. Bloom.

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Lynn, K.N., Werder, G.M., Callaghan, R.M. et al. Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol 39, 904–916 (2009). https://doi.org/10.1007/s00247-009-1336-0

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