The management and outcome of paediatric splenic injuries in the Netherlands

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in exist. This study analyses local trends aetiology and injuries evaluates the implementation guidelines proposed by American Paediatric Surgical Association (APSA) level 1 trauma centre. Methods The charts patients with blunt injury (BSI) who were admitted or transferred to centre between 2003 2020 retrospectively assessed. Information pertaining demographics, mechanism injury, description, associated injuries, intervention outcomes analysed compared international literature. Results There 130 BSI identified (63.1% male), mean age 11.3 ± 4.0 Injury Severity Score (ISS) 21.6 13.7. Bicycle accidents most common (23.1%). Sixty-four percent multi-trauma patients, 25% received blood transfusions, 31% haemodynamically unstable. Mean grade was 3.0, 30% having high-grade injury. In total, 75% underwent NOM 100% efficacy rate. Total splenectomy rate 6.2%. Four died due brain damage. Patients (grades IV–V) had significantly higher ISS longer bedrest more often presented an active blush on computed tomography (CT) scans than low-grade I–III). mainly choice both groups (76.6% 79.5%, respectively). Haemodynamic instability predictor for operative (OM) ( p = 0.001). Predictors length stay (LOS) included concomitant haemodynamic OM (all < 0.02). Interobserver agreement grading moderate, Cohens Kappa coefficient 0.493. Conclusion has proven be realistic approach low- injuries. Consideration should based instability. Compared anticipated hospital outlined APSA guidelines, Netherlands can reduce through their non-operative management. Level evidence Therapeutic study, III