A Standardized Approach for Spleen Trauma in the Children

  • Didem Baskın Embleton Afyon Kocatepe University Medical Faculty Department of Pediatric Surgery
  • Neşe Nur User Afyon Kocatepe University Medical Faculty
  • Nazan Okur Isparta State Hospital
  • Ahmet Ali Tuncer Afyon Kocatepe University Medical Faculty
  • Salih Çetinkurşun Afyon Kocatepe University Medical Faculty


Aim: The aim of this study is to evaluate the results of pediatric blunt spleen trauma patients who were treated with a standard fluid protocol.Patients and Method: Children who were treated in a university hospital for blunt spleen trauma between 2012 and 2015 were included. Age, gender, mechanism of the injury, spleen injury scale, concomitant injuries, hemoglobin levels, thrombocytopenia and thrombocytosis, administration of blood and blood products, and hospital stay duration and results were evaluated. The fluid requirements of the stable children were calculated according to Holliday-Segar equation. The fluid intake of the children was adjusted so that the urine output was 1 ml/kg/h.Results: Totally 28 children who were at the age of 3-18 years were evaluated. Injury grade(G) was G1 in 3 patients, G2 in 12 patients, G3 in 10 patients, G4 in 2 patients, and G5 in 1 patient. There were no side effects related to the fluid protocol and the monitoring of the urinary output was helpful. Grade 5 patient needed an immediate splenectomy. Thrombocytosis was developed in four patients during the hospitalization and it suggested an impaired clearance of spleen in Grade 4 patients. Re-bleeding developed in one G3 patient after discharge. No mortality was observed.Conclusion: Our management protocol was successfully applied and spleen loss was observed only in a case of grade 5 injury. Adjusting the fluid volume according to the urinary output prevented volume overload and re-bleeding. Thrombocytosis may occur after severe splenic trauma and it should be carefully followed up. 

Author Biographies

Didem Baskın Embleton, Afyon Kocatepe University Medical Faculty Department of Pediatric Surgery
Department of Pediatric Surgery
Neşe Nur User, Afyon Kocatepe University Medical Faculty
Department of Emergency Medicine
Nazan Okur, Isparta State Hospital
Department of Radiology
Ahmet Ali Tuncer, Afyon Kocatepe University Medical Faculty
Department of Pediatric Surgery
Salih Çetinkurşun, Afyon Kocatepe University Medical Faculty
Department of Pediatric Surgery


Stylianos S, APSA Trauma Committee. Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. J PediatrSurg, 2000; 2: 164-9.

Bairdain S, Litman HJ, Troy M, McMahon M, Almodovar H, Zurakowski D, et al. Twenty-years of splenic preservation at a level 1 pediatric trauma center. J PediatrSurg2015; 50:864-8.

Nytrup KB, Stensballe J, Bøttger M, Johansson PI, Ostrowski SR. Transfusion therapy in paediatric patients: a review of the literature. Scandinavian J Trauma, Resuscitation and Emergency Medicine 2015;23:21.

Tosounidis TH, Giannoudis PV. Paediatric trauma resusciation: an update. Eur J Trauma EmergSurg 2016;42:297-301.

Lee LK, Fleisher GR. Trauma management: Approach to the unstable child. http://www.uptodate.com/contents/trauma-management-approach-to-the-unstable-child, 2015 (accessed 31.03.2016)

Acker SN, Petrun B, Patrick DA, Roosevelt GE, Bensard DD. Lack of utility of repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children. J Trauma Acute Care Surg 2015; 79: 991-4.

Dodgion CM, Gosain A, Rogers A, St. Peter SD, Nichol PF, Ostlie DJ. National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol. J Ped Surg. 2014; 49: 1004-8.

Pommerening MJ, Rahbar E, Minei K, Holcomb JB, Wade CE, Schreiber MA, et al. Splenectomy is associated with hypercoagulable thromboelastopathy values and increased risk of thromboembolism. Surgery 2015;158:618-26.

Scheuerman O, Bar-Sever Z, Voffer V, Gilad O, Marcus N, Garty BZ. Functional hyposplenism is an important and underdiagnosed immunodeficiency condition in children. ActaPaediatrica 2014; 103: 399-403.

Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1994; 38:323-4.

Reyers MS. Pediatric fluid and electrolyte therapy. J PediatrPharmacolTher 2009; 14: 204–11.

Wisner DH, Kupperman N, Cooper A, Menaker J, Ehrlich P, Kooistra J, et al. Management of children with solid organ injuries after blunt torso trauma. J Trauma Acute Care Surg 2015;79: 206-14.

Notrica DM, Eubanks JW, Tuggle DW, Maxson RT, Letton RW, Garcia NM, et al.Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg 2015; 79: 683-93.

Zuckerbraun BS, Peitzman AB, Billar TR. Shock. In: Bruncardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al (editors). Schwartz's Principals of Surgery, 9th Edition, U.S.A., The Mc Graw-Hill; 2010, p. 89-112.

Acker S, Ross JT, Partrick DA, DeWitt P, Bensard DD. Injured children are resistant to the adverse effects of early high volume crystalloid resuscitation. J PediatrSurg, 2014; 49: 1852-5.

Weinrich M, Dahmen RP, Black KJL, Lange SA, Bindewald H. Postoperative long-term results in high grade traumatic ruptures of the spleen in children. ZentralblChir. 2014; 139:632-7.

Chie TL, Chesney TR, Isa D, Mnatzakanian G, Colak E, Belmont C, et al. Thrombocytosis in splenic trauma: in-hospital course and accociation with venous thromboembolism. Injury 2017; 48: 142-7.

Original Research