Wang Wu, Lei Haiyan, Zhang Wenhan, Li Wenhai, Bian Hongqiang, Yang Jun
Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
School of Medicine, Jianghan University, Wuhan, China.
Front Surg. 2024 Dec 3;11:1502557. doi: 10.3389/fsurg.2024.1502557. eCollection 2024.
Nonoperative management (NOM) is recognized as a viable treatment for pediatric closed splenic trauma. However, clinical guidelines are applied inconsistently, resulting in different treatment strategies in different regions. This study aimed to investigate the independent risk factors influencing the length of stay in pediatric closed splenic injuries and to analyze the key determinants in the choice of surgical treatment to optimize inpatient management and patient care and improve outcomes.
A retrospective evaluation of medical records of pediatric patients with blunt splenic injury (BSI) admitted to Wuhan Children's Hospital from 2020 to 2024 was conducted. The dataset included demographics, mechanism of injury, injury grade, associated injuries, therapeutic measures, and outcomes, which were subjected to statistical analysis. Factors influencing length of hospital stay and treatment regimen were also analyzed.
A total of 88.5% of patients underwent NOM, with 11% requiring splenic embolization due to hemodynamic instability or arterial hemorrhage. Surgery was required in 11.5% of patients, primarily for combined gastrointestinal perforation, or peritonitis. One patient died due to brain injury. Trauma scores and transfusion requirements were higher in the surgical group (37.7 ± 16.1 vs. 17.2 ± 13.1, < 0.001; 21.7% vs. 100%, < 0.001). Multivariate logistic regression showed that gastrointestinal complications significantly influenced the decision to operate ( = 0.0087). A generalized additive model showed a corresponding increase in length of stay with increasing injury severity, with the curve flattening in the mid to high ISS range (40-60).
NOM remains an effective and preferred treatment strategy for pediatric BSI, particularly in the setting of stable hemodynamic parameters. This approach reduces the need for surgical intervention and associated complications while preserving splenic function. The study highlights that gastrointestinal complications are important determinants of surgical management. Further research into long-term outcomes and advancements in conservative management are needed.
非手术治疗（NOM）被认为是小儿闭合性脾外伤的一种可行治疗方法。然而，临床指南的应用并不一致，导致不同地区采用不同的治疗策略。本研究旨在调查影响小儿闭合性脾损伤住院时间的独立危险因素，并分析手术治疗选择中的关键决定因素，以优化住院管理和患者护理并改善治疗结果。
对2020年至2024年入住武汉儿童医院的小儿钝性脾损伤（BSI）患者的病历进行回顾性评估。数据集包括人口统计学、损伤机制、损伤分级、合并损伤、治疗措施和治疗结果，并进行了统计分析。还分析了影响住院时间和治疗方案的因素。
共有88.5%的患者接受了非手术治疗，11%的患者因血流动力学不稳定或动脉出血需要进行脾栓塞。11.5%的患者需要手术治疗，主要是因为合并胃肠道穿孔或腹膜炎。1例患者因脑损伤死亡。手术组的创伤评分和输血需求更高（37.7±16.1对17.2±13.1，<0.001；21.7%对100%，<0.001）。多因素逻辑回归显示，胃肠道并发症显著影响手术决策（=0.0087）。广义相加模型显示，随着损伤严重程度的增加，住院时间相应增加，在中高损伤严重度评分（ISS）范围（40-60）曲线趋于平缓。
非手术治疗仍然是小儿钝性脾损伤的一种有效且首选的治疗策略，特别是在血流动力学参数稳定的情况下。这种方法减少了手术干预的必要性和相关并发症，同时保留了脾功能。该研究强调胃肠道并发症是手术治疗的重要决定因素。需要进一步研究长期结果和保守治疗的进展。
