BACKGROUND

Nonoperative management (NOM) is the standard of care for hemodynamically stable pediatric blunt liver and/or spleen injuries (BLSIs). The value of interventional radiology (IR) in NOM of pediatric BLSIs is not clearly established. This study aimed to describe the use and outcomes of IR in the management of pediatric BLSIs.

METHODS

This post hoc analysis examined data from an 83-center retrospective study called the Splenic and Hepatic Injury in Pediatric Patients study in Japan. Participants included patients 16 years or younger who sustained BLSIs and received IR interventions between January 2008 and December 2019. The patients were categorized based on the indication for initial IR: acute hemorrhage, delayed hemorrhage/ruptured pseudoaneurysm, unruptured pseudoaneurysm, and others. The primary endpoint was IR failure, defined as requiring laparotomy after deciding for NOM with IR. Descriptive statistics were used to illustrate the baseline patient characteristics and IR treatment details.

RESULTS

Among the 1,462 pediatric patients with BLSIs, 316 patients who underwent IR were evaluated. The median patient age was 11 years, and 68% were male. Organ injuries included 176, 118, and 20 splenic, liver, and simultaneous injuries, respectively. Contrast extravasation on pre-IR computed tomography imaging was found in 60.6% of the patients. The median time to IR from admission varied by indication, with the acute hemorrhage group treated in approximately 2 hours. Transcatheter arterial embolization was performed in 273 patients. In-hospital complications occurred in 7%, with IR-related complications in 0.6%. Interventional radiology failed in 3.8% of the patients, and the in-hospital mortality rate was 1.9%. Splenic salvage was successful in 98.4% of the patients.

CONCLUSION

Interventional radiology demonstrated low failure and procedural complication rates in pediatric BLSIs.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.