Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

• Splenectomy was compared with splenic angioembolization for management of splenic trauma in children.
• Less than 10% of the children require intervention for splenic injury.
• There was no difference in transfusion rates or postprocedural complications.
• Mortality rates between the 2 groups were not statistically different.

BackgroundSplenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE.MethodsThe National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting.ResultsOf 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31)ConclusionPatients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy.