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The spleen is the most frequently injured organ in blunt abdominal trauma and blunt abdominal trauma is a frequent cause of childhood injuries [1, 2]. The management of blunt splenic injuries (BSI) in pediatric patients has evolved over the past decades from primarily operative management to selective nonoperative management (NOM) [3–5]. In 1952, King and Schumacker were the first who described that splenectomised children were at risk for life-threatening infections [6]. Following reports that established the existence of a syndrome of overwhelming post splenectomy infection (OPSI), have eventually initiated the willing to preserve splenic function after trauma [7, 8]. Asplenic patients have a life time risk exceeding 5% on OPSI and this sepsis-syndrome has a mortality rate ranging between 50 and 80% [9–11]. While there are multiple advantages to selective NOM, there are also potential drawbacks. Failure of NOM (fNOM), defined as the need for surgical intervention in patients that were initially selected for conservative management, is associated with increased morbidity and mortality [12–14]. Selective nonoperative management has proven highly successful, and success rates in pediatric patients exceeding 90% have been published [15–17]. However, the exact criteria by which patients are selected for NOM has changed over time and continues to be debated [18–20]. In our institution, however, treatment guidelines have not changed over time. All children who are hemodynamically stable and without clinical signs of hollow viscus or diaphragm injury are selected for NOM. Furthermore, when surgical intervention is indicated we prefer to utilize spleen-preserving operative procedures in children. The current study was conducted to determine the outcome of our selective NOM focussed protocol in children with blunt splenic injury. Moreover, we aimed to identify factors associated with persistent hemodynamic instability present in the emergency department that thereby mandated early surgical intervention in children. It is believed that splenic injury grading systems poorly predict the need for surgical intervention for blunt splenic trauma in adults [21]. Nevertheless, given the unique anatomical characteristics of the pediatric spleen, including a relatively thick capsule with enhanced arrangement of elastic capsular fibers. [22, 23], we hypothesized that splenic injury severity is predictive for surgical intervention in children with blunt splenic trauma.

Splenic injury severity, not admission hemodynamics, predicts need for surgery in pediatric blunt splenic trauma