Pediatric Splenectomy for Traumatic Injuries: How Are We Doing?

Background: Splenic salvage, including non-operative management and angioembolization, is highly recommended in the management of splenic injuries in pediatric patients ( <16 years of age). We sought to evaluate trends in splenectomy and outcomes of splenic injuries in pediatric patients using the National Trauma Databank (NTDB).

Methods: We queried the National Trauma Databank (NTDB) to include all pediatric (age < 16) splenic injuries from 2007-2018. Four cohorts (splenectomy, splenic salvage, failed salvage, and no intervention) were formed based upon ICD coded procedures listed for each patient. We define failed splenic salvage if patients required splenectomy following splenic salvage management strategies. Demographics, vital signs, procedures and outcomes were abstracted. Patient outcomes and characteristics were compared among groups. We performed a Poisson regression analysis to predict factors independently associated with splenectomy.

Results: A total of 30,363 children that met inclusion criteria –27,306 (89.9%) were managed non-operatively (NOM), 1,716 (5.7%) underwent splenectomy, 1,313 (4.3%) had splenic salvage, and 28 failed management with splenic salvage. The proportion of patients who were managed with splenectomy declined over the study period, while the proportion of those undergoing splenic salvage increased (Figure 1). Patients who failed splenic salvage had significantly higher injury severity scores (33.4 ±13.9) than those who underwent splenectomy (30.6±16.1) , had splenic salvage (22.4 ±13.6)), or non-operative management (16.4 ±12.1)) (p < 0.01). Patients who underwent splenectomy had higher mortality rates than splenic salvage or NOM (18.4% vs. 3.1% vs. 3.5%, p<0.01). On multivariate Poisson regression analysis, increasing age (IRR: 1.11; 95%CI: 1.09-1.13), penetrating injury type (IRR: 4.44; 95%CI: 3.36-5.38), and increasing injury severity score (IRR: 1.05; 95% CI:1.05-1.05) were independently associated with increased rate of splenectomy.

Conclusion: In pediatric patients, most splenic injuries are managed with splenic salvage strategies, indicating general adherence to current guidelines regarding the management of splenic injuries. Factors associated with splenectomy are increasing age, higher injury severity score and penetrating injury type.