Evolution in the management of splenic injury in children

: To assess the changes in the management of splenic trauma, the charts of all patients with splenic injury, documented either roentgenographically or at operation, treated at the Childrens Hospital of Los Angeles from 1965 through 1985 were reviewed. One hundred and eleven patients with confirmed splenic injury were treated. Forty-one patients were seen during the first decade (1965 to 1975) and 70 during the second decade (1976 to 1985). The majority of patients were boys with a mean age of seven years. All of the patients sustained blunt abdominal trauma. During the first decade, all of the patients who had a recognized splenic injury underwent splenectomy. In the second decade, 44 patients were treated without surgical intervention. Twenty-six of the patients required surgical treatment. Splenorrhaphy was successful in 15; however, splenectomy was required in 11 patients. The patients who required surgical therapy had more complications and required more blood products than those patients who were treated nonsurgically. The overall survival rate was 95 per cent and was similar in both decades. Associated injuries, not the splenic injury, were responsible for the lethal outcome of the nonsurvivors. Although the majority of children with splenic injury can be managed nonoperatively, surgical intervention continues to be necessary in our experience in approximately 38 per cent of the patients with an over-all splenic salvage rate of 85 per cent.