Updated APSA Guidelines for the Management of Blunt Liver and Spleen Injuries |
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| Institution: | 1. Le Bonheur Children''s Hospital, 49 North Dunlap Avenue, Second Floor, Memphis, Tn, 38105, USA;2. Drexel University College of Medicine, St Christopher''s Children''s Hospital, 160 East Erie Avenue, Philadelphia, PA, 19134, USA;3. Phoenix Children''s Hospital, 1919 E Thomas Road, Phoenix, Az, 85016, USA;4. University of Texas Medical Branch, 712 Texas Avenue, Galveston, TX, 77555, USA;5. Division of Pediatric Surgery -Staten Island University Hospital/CCMC/Northwell Health, 378 Seaview Ave., Lower Level. Staten Island, NY, 10305, USA;6. Children''s of Alabama, 1600 7th Avenue South, Lowder Bldg., Suite 300, Birmingham, AL, 35233, USA;7. Department of Surgery, Texas Children''s Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, TX, 77030, USA;8. Divsion of Pediatric Surgery, Columbia University Vagelos College of Physicians & Surgeons;9. Section of Pediatric Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston–Salem, NC, 27157, USA |
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| Abstract: | BackgroundNon-operative management of blunt liver and spleen injuries was championed initially in children with the first management guideline published in 2000 by the American Pediatric Surgical Association (APSA). Multiple articles have expanded on the original guidelines and additional therapy has been investigated to improve care for these patients. Based on a literature review and current consensus, the management guidelines for the treatment of blunt liver and spleen injuries are presented.MethodsA recent literature review by the APSA Outcomes committee 2] was utilized as the basis for the guideline recommendations. A task force was assembled from the APSA Committee on Trauma to review the original guidelines, the literature reported by the Outcomes Committee and then to develop an easy to implement guideline.ResultsThe updated guidelines for the management of blunt liver and spleen injuries are divided into 4 sections: Admission, Procedures, Set Free and Aftercare. Admission to the intensive care unit is based on abnormal vital signs after resuscitation with stable patients admitted to the ward with minimal restrictions. Procedure recommendations include transfusions for low hemoglobin (<7 mg/dL) or signs of ongoing bleeding. Angioembolization and operative exploration is limited to those patients with clinical signs of continued bleeding after resuscitation. Discharge is based on clinical condition and not grade of injury. Activity restrictions remain the same while follow-up imaging is only indicated for symptomatic patients.ConclusionThe updated APSA guidelines for the management of blunt liver and spleen injuries present an easy-to-follow management strategy for children.Level of EvidenceLevel 5. |
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| Keywords: | Pediatric trauma Blunt trauma Solid organ injury Treatment guidelines |
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