The incidence of delayed splenic bleeding in pediatric blunt trauma

Background: One of the concerns associated with nonoperative management of splenic injury in children has been delayed splenic bleed (DSB) after a period of hemostasis. This study evaluates the incidence of DSB from a multicenter 3-year prospective study of blunt splenic injuries (BSI). Methods: A 3-year prospective study was done to evaluate nonoperative management of pediatric (≤ 18 years) BSI presenting to one of 10 pediatric trauma centers. Patients were tracked at 14 and 60 days. Descriptive statistics were used to summarize patient and injury characteristics. Results: During the study period, 508 children presented with BSI. Median age was 11.6 [IQR: 7.0, 14.8]; median splenic injury grade was 3 [IQR: 2, 4]. Nonoperative management was successful in 466 (92%) with 18 (3.5%) patients undergoing splenectomy at the index admission, all within 3 h of injury. No patient developed a delayed splenic bleed. At least one follow-up visit was available for 372 (73%) patients. Conclusion: A prior single institution study suggested that the incidence of DSB was 0.33%. Based on our results, we believe that the rate may be less than 0.2%. Level of evidence: Level II, Prognosis.