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

Abstract

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.