INJURY GRADE DOES NOT INFLUENCE OUTCOME IN CHILDREN WITH BLUNT LIVER AND SPLEEN TRAUMA

Objective: To determine if injury grade (IG) influences outcome; need for operative intervention (OP), blood transfusion, or survival, following blunt pediatric liver (L) and spleen (S) trauma. Methods: A review of 111 children with 114 blunt liver/spleen injuries treated from 1989 to 1995. All hemodynamically stable patients were initially treated non-operatively (NONOP). Diagnosis (L-78, S-36) and grading (L-59, S-34) of injury was made by CT scan or at OP. IG, survival, ISS, hemodynamic stability, blood transfused, associated injuries were analyzed. Results are reported as means. Statistical analysis was performed using Kruskal-Wallis, ANOVA, and Chi-squared tests. Results: Age was 7.4 years, IG was 2.8, ISS was 11.5 and mean transfusion was 12 ml/kg of packed red blood cells (PRBC). 12 of 78 (15%) with liver injuries and 7 of 36 (19%) with splenic injury had OP. Mean IG of 2.8 in OP, was no different than NONOP (p=0.8). IG was similar in transfused vs. no transfusion, 2.8 vs. 2.7 (p=0.4), and in stable vs. unstable, 2.7 vs. 2.9 (p=0.8). Mean PRBC requirement was higher in OP vs. NONOP, 51 vs. 6 ml/kg (p=0.0001), and OP patients had a higher ISS, 17 vs. 10 (p=0.01). There were 77 patients (69%) with associated injuries of whom 15 died (none as a result of liver/spleen injury); and 34 (31%) isolated liver/spleen injuries, with one death. Death was associated with unstable hemodynamics (p=0.0005), a higher ISS, 23 vs. 9.7 (p=0.0005), and higher PRBC, 56 vs. 7 (p=0.0001), but not higher IG, 2.5 vs. 2.8 (p=0.3). Conclusion: Injury grade does not influence outcome following blunt pediatric liver and spleen trauma. Higher ISS, PRBC requirement, and hemodynamic instability predicted need for operation, as well as death.
H Grewal MD(*), CW Wagner MD, RJ Jackson MD, SD. Smith MD, FAAP, D Parnell RN, MNSc, S Helmer PhD(*); (*)UKS of Medicine-Wichita, KS 67208 & Arkansas Children's Hospital, Little [...]