Reimaging in pediatric blunt spleen and liver injury

• Published in: Journal of pediatric surgery Vol. 54; no. 2; pp. 340 - 344
• Main Authors: Notrica, David M., Sussman, Bethany L., Garcia, Nilda M., Leys, Charles M., Maxson, R. Todd, Bhatia, Amina, Letton, Robert W., Ponsky, Todd, Lawson, Karla A., Eubanks, James W., Alder, Adam C., Greenwell, Cynthia, Ostlie, Daniel J., Tuggle, David W., St. Peter, Shawn D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2019
• Subjects: Abdominal trauma; Blunt trauma; Liver injury; Pediatric; Reimaging; Spleen injury; Abdominal trauma; Blunt trauma; Spleen injury; Pediatric; Reimaging; Liver injury
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2018.08.060

APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients.
A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60 days. Patients with re-injury after discharge were excluded.
Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention.
Selective abdominal reimaging for BLSI was done in 6% of patients, and 11% of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14 days did not prompt intervention in any of the 534 patients managed nonoperatively.
Level II, Prognosis.