Management of pediatric splenic trauma

Aim: Here, we aim to reveal the management and treatment processes of the patients, to discuss the non-operative treatment management, and to present our experiences by retrospectively scanning the patients we followed up for spleen trauma between January 2010 and December 2019. Materials and Methods: 244 patients with spleen injury who applied to Dicle University Faculty of Medicine were included in the study. The age and gender of the patients were recorded. The cause of injury, stage of injury, comorbidity, blood transfusion, length of stay, and accompanying organ injuries were evaluated. Blood pressure, HCT, Hb, PLT, NEU, LYM, lactate, NEU/LYM ratio, PLT/LYM ratio were measured. GCS stage, urine output, mortality, morbidity, radiological examinations and treatment management were evaluated. IBM SPSS Statistics Version 18.0 program was used for statistical analysis of the data. Results: Spleen injury was present in 22% of trauma patients who presented to the emergency department and were consulted with pediatric surgery. While falling was the first cause of spleen injury with 60%, it was seen that the most common application due to trauma was traffic accidents. 43% of the patients were in school childhood. 90% of the patients had stage 1-2-3 spleen injury. The mean age at presentation was 7.90, the mean hematocrit was 32, and the mean hemoglobin was 10.90. Transfusion was given to 29% of the patients. 45.9% of the patients had additional injuries and the most frequently injured organ was the lung. The mean hospital stay was 6.03 days. Mortality was seen in 5 patients and morbidity in 5 patients. There was a statistically highly significant correlation between blood pressure and urine output and mortality. (p<0.001) A statistically highly significant correlation was observed between the type of trauma and surgery (p<0.001), and there was a statistically significant correlation between additional injury and surgery. p<0.01) A very high statistically significant correlation was found between Platelet/Lymphocyte ratio, blood transfusion, hemoglobin, GCS and mortality. (p<0.001) A statistically highly significant correlation was found between GCS, length of stay, neutrophil count and additional injury. (p<0.001) It was observed that there was a high level of negative correlation between lactate, VI blood transfusion and GCS. (r= -0.610 and r= -0.645, respectively) In the ROC analysis for lactate and additional injury, sensitivity was found 58% and specificity 83% at a cut-off value of 1.9 for lactate. Conclusion: We recommend non-operative treatment to patients with spleen injury because it reduces both mortality, morbidity and cost. Treatment management of patients should be scientifically standardized. The most important goal in preventing trauma-related mortality and morbidity is to prevent trauma. Children should be raised safely, away from violence, and societies should be educated on this issue. Keywords: spleen trauma in children, nonoperative treatment