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Ignat’ev V.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

Oleynik A.V.

Vernadsky Crimean Federal University

Muraviev A.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

Garapov T.A.

Sevastopol City Hospital No. 1

Dankova I.I.

Sevastopol City Hospital No. 1

Tishukov M.Yu.

Georgievsky Medical Academy

Treatment of children with blunt spleen injury throughout 25-year period in Sevastopol and the Republic of Crimea

Authors:

Ignat’ev V.V., Oleynik A.V., Muraviev A.V., Garapov T.A., Dankova I.I., Tishukov M.Yu.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2025;(2): 67‑76

DOI: 10.17116/hirurgia202502167

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Table of contents

TREATMENT OF CHILDREN WITH BLUNT SPLEEN INJURY THROUGHOUT 25-YEAR PERIOD IN SEVASTOPOL AND THE REPUBLIC OF CRIMEA
TREATMENT OF CHILDREN WITH BLUNT SPLEEN INJURY THROUGHOUT 25-YEAR PERIOD IN SEVASTOPOL AND THE REPUBLIC OF CRIMEA

To cite this article:

Ignat’ev VV, Oleynik AV, Muraviev AV, Garapov TA, Dankova II, Tishukov MYu. Treatment of children with blunt spleen injury throughout 25-year period in Sevastopol and the Republic of Crimea. Pirogov Russian Journal of Surgery. 2025;(2):67‑76. (In Russ.)
https://doi.org/10.17116/hirurgia202502167

 
Подписка 2025-2 (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
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OBJECTIVE

This study examines methods of treatment of pediatric patients with blunt splenic injury (BSI) in medical institutions in the city of Sevastopol and the Republic of Crimea. The effectiveness of non-operative management (NOM) in patients with BSI of varying AAST injury grade was assessed and risk factors which could predict the need for operative management (OM) were identified.

MATERIAL AND METHODS

A two-center retrospective cohort study was performed, in which reviewed the medical records of children diagnosed with BSI between 1996 and 2023. A cohort of patients hospitalized since the start of the active use of NOM of BSI was identified to determine risk factors.

RESULTS

The study included 112 patients. The mean age was 9.9±3.6 years, with a predominantly male (72%) population. In 64% of cases, the injury mechanism of BSI was a fall from a height. 26% of patients were hemodynamically unstable. Among the cohort of patients hospitalized since the start of the active use of NOM of BSI, NOM was effective in 94% of patients with low or moderate AAST injury grade, and in 56% of patients with high AAST injury grade. According to the study results, the risk factors that determine the indications for OM in this cohort of patients are BSI of high AAST injury grade (OR 20.0; 95% CI 2.7—53; p<0.01), hemoperitoneum volume >500 ml according to ultrasound and/or CT (OR 15.0; 95% CI 2.3—98; p< 0.01), Hb <92.5 g/l (OR 20.0; 95% CI 1.9—219; p=0.01), hemodynamic instability (OR 5.4; 95% CI 1.4—21; p=0.02).

CONCLUSION

NOM is an effective treatment for BSI of any AAST injury grade. The decision about OM should be based on haemodynamic instability.

Keywords:

blunt splenic trauma
paediatric
non-operative management
splenectomy
risk factors

Authors:

Ignat’ev V.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

Oleynik A.V.

Vernadsky Crimean Federal University

Muraviev A.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

Garapov T.A.

Sevastopol City Hospital No. 1

Dankova I.I.

Sevastopol City Hospital No. 1

Tishukov M.Yu.

Georgievsky Medical Academy

Received:

07.04.2024

Accepted:

26.04.2024

List of references:

  1. Fisenko AP, Timofeeva AG, Terletskaya RN, Konova SR, Lazurenko SB. External reasons related mortality in the children population of the Russian Federation. Russian Pediatric Journal. 2020;23(2):116-125. (In Russ.). https://doi.org/10.18821/1560-9561-2020-23-2-116-125
  2. Godbole P, Stringer MD. Splenectomy after paediatric trauma: could more spleens be saved? Annals of the Royal College of Surgeons of England. 2002;84:106-108. 
  3. Gaines BA, Ford HR. Abdominal and pelvic trauma in children. Critical Care Medicine. 2002;30:416-423.  https://doi.org/10.1097/00003246-200211001-00006
  4. Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G, Stella F. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Annali Italiani di Chirurgia. 2010;81:95-102. 
  5. Klimek PM, Lutz T, Stranzinger E, Zachariou Z, Kessler U, Berger S. Handlebar injuries in children. Pediatric Surgery International. 2013;29:269-273.  https://doi.org/10.1007/s00383-012-3227-y
  6. Upadhyaya P, Simpson JS. Splenic trauma in children. Surgery, Gynecology and Obstetrics. 1968;126:781-790. 
  7. Podkamenev VV, Pikalo IA. The criteria for choose of treatment method of children with spleen injuries. Pediatric Surgery. 2014;18(5):23-27. (In Russ.).
  8. Yang K, Li Y, Wang C, Xiang B, Chen S, Ji Y. Clinical features and outcomes of blunt splenic injury in children: A retrospective study in a single institution in China. Medicine. 2017;96(51):e9419. https://doi.org/10.1097/MD.0000000000009419
  9. McVay MR, Kokoska ER, Jackson RJ, Smith SD. Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status. Journal of Pediatric Surgery. 2008;43:1072-1076. https://doi.org/10.1016/j.jpedsurg.2008.02.031
  10. Potoka DA, Schall LC, Ford HR. Risk factors for splenectomy in children with blunt splenic trauma. Journal of Pediatric Surgery. 2002;37:294-299.  https://doi.org/10.1053/jpsu.2002.30824
  11. Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, Kaups K, Schuster K, Tominaga GT; AAST Patient Assessment Committee. Organ injury scaling 2018 update: Spleen, liver, and kidney. Journal of Trauma and Acute Care Surgery. 2018;85:1119-1122. https://doi.org/10.1097/TA.0000000000002058
  12. Tepas JJ, Mollitt DL, Talbert JL, Bryant M. The pediatric trauma score as a predictor of injury severity in the injured child. Journal of Pediatric Surgery. 1987;22:14-18.  https://doi.org/10.1016/S0022-3468(87)80006-4
  13. Karadeniz Cerit K, Ergelen R, Abdullayev T, Tuğtepe H, Dağlı TE, Kıyan G. The effectiveness of non-operative treatment in high-grade liver and spleen injury. Ulusal Travma ve Acil Cerrahi Dergisi. 2018;24(6):569-574.  https://doi.org/10.5505/tjtes.2018.83573
  14. Shapkina AN, Kozlova MV, Shmyreva ES, Shumatov VB. How to avoid splenectomy in a child with splenic trauma. Pacific Medical Journal. 2018;1:72-4. (In Russ.). https://doi.org/10.17238/PmJ1609-1175.2018.1.72-74
  15. Stottlemyre RL, Notrica DM, Cohen AS, Sayrs LW, Naiditch J, St Peter SD, Leys CM, Ostlie DJ, Maxson RT, Ponsky T, Eubanks JW 3rd, Bhatia A, Greenwell C, Lawson KA, Alder AC, Johnson J, Garvey E. Hemodilution in pediatric trauma: Defining the expected hemoglobin changes in patients with liver and/or spleen injury: An ATOMAC+ secondary analysis. Journal of Pediatric Surgery. 2023;58:325-329.  https://doi.org/10.1016/j.jpedsurg.2022.10.044
  16. Loggers SAI, Koedam TWA, Giannakopoulos GF, Vandewalle E, Erwteman M, Zuidema WP. Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members. European Journal of Trauma and Emergency Surgery. 2017;43:823-833.  https://doi.org/10.1007/s00068-016-0744-8
  17. Stivelman RL, Glaubitz JP, Crampton RS. Laceration of the spleen due to nonpenetrating trauma. American Journal of Surgery. 1963;106: 888-891.  https://doi.org/10.1016/0002-9610(63)90151-X
  18. Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: Actual versus perceived risks. British Journal of Surgery. 2005;78:1031-1038. https://doi.org/10.1002/bjs.1800780904
  19. Podkamenev VV, Iurkov PS, Mikhaĭlov NI, Ivanov VO, Nigamad’ianov NR. Treatment of closed spleen injuries with intraabdominal bleeding in children. Pirogov Russian Journal of Surgery. 2010;4:47-50. (In Russ.).
  20. Davies DA, Pearl RH, Ein SH, Langer JC, Wales PW. Management of blunt splenic injury in children: evolution of the nonoperative approach. Journal of Pediatric Surgery. 2009;44:1005-1008. https://doi.org/10.1016/j.jpedsurg.2009.01.024
  21. Holmes JH 4th, Wiebe DJ, Tataria M, Mattix KD, Mooney DP, Scaife ER, Brown RL, Groner JI, Brundage SI, Tres Scherer LR 3rd, Nance ML. The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. Journal of Trauma. 2005;59(6):1309-13.  https://doi.org/10.1097/01.ta.0000197366.38404.79
  22. Van Der Vlies CH, Saltzherr TP, Wilde JCH, Van Delden OM, De Haan RJ, Goslings JC. The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. Journal of Pediatric Surgery. 2010;45:1044-1049. https://doi.org/10.1016/j.jpedsurg.2010.01.002
  23. Powell M, Courcoulas A, Gardner M, Lynch J, Harbrecht BG, Udekwu AO, Billiar TR, Federle M, Ferris J, Meza MP, Peitzman AB. Management of blunt splenic trauma: Significant differences between adults and children. Surgery. 1997;122:654-660.  https://doi.org/10.1016/S0039-6060(97)90070-2
  24. Morse MA, Garcia VF. Selective nonoperative management of pediatric blunt splenic trauma: Risk for missed associated injuries. Journal of Pediatric Surgery. 1994;29:23-27.  https://doi.org/10.1016/0022-3468(94)90516-9
  25. Fick AEA, Raychaudhuri P, Bear J, Roy G, Balogh Z, Kumar R. Factors predicting the need for splenectomy in children with blunt splenic trauma: Children with blunt splenic trauma. ANZ Journal of Surgery. 2011;81:717-719.  https://doi.org/10.1111/j.1445-2197.2010.05591.x
  26. Aoki M, Abe T, Hagiwara S, Saitoh D, Oshima K. Isolated high-grade splenic injury among pediatric patients in Japan: Nationwide descriptive study. Journal of Pediatric Surgery. 2021;56:1030-1034. https://doi.org/10.1016/j.jpedsurg.2020.07.011
  27. Aoki M, Abe T, Saitoh D, Oshima K. Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan. Scientific Reports. 2019;9(1):917.  https://doi.org/10.1038/s41598-018-37579-3
  28. Grootenhaar M, Lamers D, Ulzen KK, De Blaauw I, Tan EC. The management and outcome of paediatric splenic injuries in the Netherlands. World Journal of Emergency Surgery. 2021;16:8.  https://doi.org/10.1186/s13017-021-00353-4
  29. Podkamenev VV, Pikalo IA. Concept of spontaneous hemostasis in trauma spleen in children. Medical News of the North Caucasus. 2016;11(3):409-413. (In Russ.). https://doi.org/10.14300/mnnc.2016.11090
  30. Gross JL, Woll NL, Hanson CA, Pohl C, Scorpio RJ, Kennedy AP Jr, Coppola CP. Embolization for pediatric blunt splenic injury is an alternative to splenectomy when observation fails. Journal of Trauma and Acute Care Surgery. 2013;75(3):421-425.  https://doi.org/10.1097/TA.0b013e3182995c70
  31. Keller MS. Blunt injury to solid abdominal organs. Seminars in Pediatric Surgery. 2004;13(2):106-111.  https://doi.org/10.1053/j.sempedsurg.2004.01.006
  32. Rumyantseva GN, Kazakov AN, Volkov SI, Yusufov AA, Brevdo YuF, Portenko YuG. More on the Modern Approach to Diagnostics and Treatment of Spleen Trauma in Children. Russian Sklifosovsky Journal “Emergency Medical Care”. 2021;10:168-173. (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-1-168-173
  33. Ardley R, Carone L, Smith S, Spreadborough S, Davies P, Brooks A. Blunt splenic injury in children: haemodynamic status key to guiding management, a 5-year review of practice in a UK major trauma centre. European Journal of Trauma and Emergency Surgery. 2019;45(5):791-799.  https://doi.org/10.1007/s00068-018-1014-8
  34. Lee J, Moriarty KP, Tashjian DB. Less Is More: Management of Pediatric Splenic Injury. The Archives of Surgery. 2012;147(5):437-441.  https://doi.org/10.1001/archsurg.2012.141
  35. Adams SE, Holland A, Brown J. A comparison of the management of blunt splenic injury in children and young people — A New South Wales, population-based, retrospective study. Injury. 2018;49:42-50.  https://doi.org/10.1016/j.injury.2017.08.023

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