We undertook a retrospective study of pediatric blunt splenic injuries treated nonoperatively at our institution from 1990 to 1995 (n=72) to assess the impact of serial computed tomography (CT) scans on the outcome. Median number of studies per child was three. The result showed that the appearance of the splenic injury remained unchanged or improved in 95% of the imaging studies obtained (116 of 122). Only one of five patients with an image suggesting a worsening splenic injury required operative intervention. There were no instances of missed injuries, delayed ruptures, or readmissions. We conclude that serial CT scans have limited follow-up value and should be used selectively.
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References
1.
1. Karp MP, Cooney DR, Berger PE, et al. The role of computed tomography in the evaluation of blunt abdominal trauma in children. J Pediatr Surg. 1981;16:316-323.
2.
2. Raptopoulos V.Abdominal trauma: emphasis on computed tomography. Radiol Curn North Am. 1994;32:969-986.
3.
3. Taylor G.Imaging of pediatric blunt abdominal trauma: What have we learned in the past decade?Radiology1995;195:600-601.
5. Hebeler RF, Ward RE, Miller PW, Ben Menachem Y.The management of splenic injury. J Trauma. 1982;22:492-495.
6.
6. Smith JS, Wengrov itz MA, DeLong BS. Prospective validation of criteria, including age, for safe, nonsurgical management of the ruptured spleenJ Trauma. 1992;33:363-369.
7.
7. Tricarico A, Sicoli S, Calise F, et al. Conservative treatment in splenic trauma. J R Coll Surg Edinb. 1993;38: 145-148.
8.
8. Jeffrey R.CT diagnosis of blunt hepatic and splenic injuries: a look to the future. Radiology. 1989;171:17-18.
9.
9. Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling; spleen, liver, and kidney. J Trauma. 1989;29: 1664-1666.
10.
10. Lupien C, Saurbrei EF. Healing in the traumatized spleen: sonographic investigation. Indiana Med. 1984;151: 181-185.
11.
11. Do HM, CronanJj. CT appearance of splenic injuries managed nonoperatively. AmJRadiol. 1991;157:757-760.
12.
12. Rescorla FJ, Grosfeld JL. Splenic and liver trauma in children. Indiana Med. 1989;82:516-523.
13.
13. Howman-Giles R, Gilday DL, Venugopal S, et al. Splenic trauma-nonoperative management and long-term follow-tup by scintiscan. J Peiiatr Surg. 1978;13:121-126.
14.
14. Fischer KC, Eraklis A, Rossello P, Treves S.Scintigraphy in the follow-up of pediatric splenic trauma treated without surgery.JNuclMed. 1978;19:3-9.
15.
15. Bethel CAI, Touloukian RJ, Seashore JH, Rosenfield NS. Outcome of nonoperative management of splenic injury with nuclear scanning: clinical significance of persistent abnormalities. AmJDis Child. 1992;146:198-200.
16.
16. Mirvis SE, Whiltey NO, Gens DR. Blunt splenic trauma in adults: CT based classification and correlation with prognosis and treatment. Radiology. 1989;171:33-39.
17.
17. Benya EC, Bulas DI, Eichelberger MR, Sivit CJ. Splenic injury from blunt abdominal trauma in children: follow up evaluation with CTRadiology. 1995;195:685-688.
18.
18. Allen JE. Splenic injuries at the Children's Hospital of Buffalo, 1980-89 (personal communication).
19.
19. Shandling B.Conservative management of ruptured spleen. S Afr MedJ1980;57:655-658.
20.
20. Ein SH, Shandling B, Simpson JS, Stephens CA. Nonoperative management of traumatized spleen in children: how and why. J Pediatr Surg. 1978;13:117-119.
21.
21. Moss JF, Hopkins WM. Nonoperative management of blunt splenic trauma in the adult: a community hospital's experience.J Trauma. 1987;27:315-318.
22.
22. Aronson DZ, Scherz AW, Einhorn AH, et al. Nonoperative management of splenic trauma in children: a report of six consecutive cases. Pediatrics. 1977;60:482-485.
23.
23. Lawson DE, Jacobson JA, Spizarny DL, Pranikoff T.Splenic trauma: value of follow-up CT. Radiology. 1995;194: 97-100.
24.
24. Pranikoff T, Hirschl RB, Schlesinger AE, et al. Resolution of splenic injury after nonoperative management. JPe diatr Surg. 1994;29:1366-1369.
25.
25. King DR, Lobe TE, Haase GM, Boles ET. Selective management of injured spleen. Surgery. 1981;90:677-682.
