Blunt hepatic and splenic trauma in children : correlation of a CT injury severity scale with clinical outcome

• Published in: Pediatric radiology 1995-07, Vol.25 (5), p.321-325
• Main Authors: RUESS, L, SIVIT, C. J, EICHELBERGER, M. R, TAYLOR, G. A, BOND, S. J
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Blood Transfusion; Child; Child, Preschool; Female; Hemostasis, Surgical; Humans; Infant; Injuries of the abdomen. Foreign bodies of the digestive system; Injury Severity Score; Liver - diagnostic imaging; Liver - injuries; Liver - surgery; Male; Medical sciences; Outcome Assessment (Health Care); Prospective Studies; Spleen - diagnostic imaging; Spleen - injuries; Spleen - surgery; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Wounds, Nonpenetrating - classification; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/BF02021691

The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by chi 2-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by chi 2-test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury.