Physiology after pediatric splenic injury.

Background: The splenic injury computed tomographic (CT) grade is used to guide nonoperative management. A study was conducted to determine whether this grade correlates with patient physiology. Methods: Records of consecutive children with isolated spleen injuries were reviewed. Vital signs, fluids administered, urine output, and hematocrit values from the scene through 120 hours after admission were retrieved. A blinded radiologist reviewed CT scans. Statistical analyses were conducted to test for a linear relationship between injury grade and physiologic parameters. Results: Eighty-two patients with isolated splenic injuries and available CT scans were located. CT injury grade correlated directly with pulse, systolic blood pressure, and diastolic blood pressure and inversely with hematocrit. No correlation was found with pulse pressure, urine output, or maximum temperature. Conclusion: The CT grade of splenic injury correlates directly with pulse, systolic blood pressure, and diastolic blood pressure and inversely with hematocrit. CT injury grade correlates with physiologic impact and may guide management decisions.