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Eur J Pediatr Surg 2022; 32(06): 497-503
DOI: 10.1055/s-0042-1749643
Original Article

European Pediatric Surgeons' Association Survey on the Use of Splenic Embolization in Blunt Splenic Trauma in Children

Anne Dariel
1   Pediatric Surgery Department, Assistance Publique des Hôpitaux de Marseille, Marseille, France
,
Tutku Soyer 
2   Pediatric Surgery Department, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
,
Jens Dingemann 
3   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Alessio Pini-Prato 
4   UO Chirurgia Pediatrica, AON SS Antonio e Biago e Cesare Arrigo, Alessandria, Italy
,
Leopoldo Martinez
5   Pediatric Surgery Department, Hospiltal Infantil La Paz, Madrid, Spain
,
Alice Faure
1   Pediatric Surgery Department, Assistance Publique des Hôpitaux de Marseille, Marseille, France
,
Mamane Oumarou
1   Pediatric Surgery Department, Assistance Publique des Hôpitaux de Marseille, Marseille, France
,
Sophie Hassid
6   Pediatric Intensive Care Unit, Hôpital La Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
,
Alexia Dabadie
7   Pediatric Radiology Department, Assistance Publique des Hôpitaux de Marseille, Marseille, France
,
Paolo De Coppi
8   Department of Paediatric Surgery, GOS Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
,
Ramon Gorter
9   Pediatric Surgery Department, Emma Childrens' Hospital UMC, Amsterdam, the Netherlands
,
Tkashi Doi
10   Pediatric Surgery Department, Kansai Medical University, Osaka, Japan
,
Sanja Sindjic Antunovic
11   Pediatric Surgery Unit, Medical Faculty University of Belgrade, Belgrade, Serbia
,
Mohit Kakar
12   Pediatric Surgery Department, Children's Clinical University Hospital, Rīga, Latvia
,
Francesco Morini
13   Neonatal Surgery Unit, Azienda Ospedaliero-Universitaria Meyer, University of Florence, Florence, Italy
,
Nigel J. Hall
14   University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
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Abstract

Introduction This article assesses (1) access to splenic embolization (SE), (2) indications for SE, and (3) post-embolization management in high-grade splenic trauma in children.

Materials and Methods An online questionnaire was sent in 2021 to all members of European Pediatric Surgeons' Association.

Results There were a total of 157 responses (50 countries, 83% academic hospitals). Among them, 68% have access to SE (SE) and 32% do not (nSE). For a hemodynamic stable patient with high-grade isolated splenic trauma without contrast extravasation (CE) on computed tomography (CT) scan, 99% SE and 95% nSE respondents use nonoperative management (NOM). In cases with CE, NOM decreases to 50% (p = 0.01) and 51% (p = 0.007) in SE and nSE centers, respectively. SE respondents report a significant reduction of NOM in stable patients with an associated spine injury requiring urgent surgery in prone position, both without and with CE (90 and 28%, respectively). For these respondents, in stable patients the association of a femur fracture only tends to decrease the NOM, both without and with CE (93 and 39%, respectively). There was no significant difference in NOM in group nSE with associated injuries with or without CE. After proximal SE with preserved spleen vascularization on ultrasound Doppler, 44% respondents prescribe antibiotics and/or immunizations.

Conclusion Two-thirds of respondents have access to SE. For SE respondents, SE is used even in stable patients when CE showed on initial CT scan and its use increased with the concomitant need for spinal surgery. There is currently a variation in the use of SE and antibiotics/immunizations following SE.

Keywords

splenic trauma - embolization - children - survey

Supplementary Material



Publication History

Received: 18 July 2021

Accepted: 11 January 2022

Article published online:
26 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Gates RL, Price M, Cameron DB. et al. Non-operative management of solid organ injuries in children: an American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg 2019; 54 (08) 1519-1526
    CrossrefPubMedGoogle Scholar
  • 2 Stylianos S. Compliance with evidence-based guidelines in children with isolated spleen or liver injury: a prospective study. J Pediatr Surg 2002; 37: 453-456
    CrossrefPubMedGoogle Scholar
  • 3 Notrica DM, Eubanks III JW, Tuggle DW. et al. Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg 2015; 79 (04) 683-693
    CrossrefPubMedGoogle Scholar
  • 4 Polites SF, Zielinski MD, Zarroug AE, Wagie AE, Stylianos S, Habermann EB. Benchmarks for splenectomy in pediatric trauma: how are we doing?. J Pediatr Surg 2015; 50 (02) 339-342
    CrossrefPubMedGoogle Scholar
  • 5 Holmes IV JH, Wiebe DJ, Tataria M. et al. The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. J Trauma 2005; 59 (06) 1309-1313
    CrossrefPubMedGoogle Scholar
  • 6 Knight M, Kuo YH, Ahmed N. Risk factors associated with splenectomy following a blunt splenic injury in pediatric patients. Pediatr Surg Int 2020; 36 (12) 1459-1464
    CrossrefPubMedGoogle Scholar
  • 7 Schuster T, Leissner G. Selective angioembolization in blunt solid organ injury in children and adolescents: review of recent literature and own experiences. Eur J Pediatr Surg 2013; 23 (06) 454-463
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Swendiman RA, Goldshore MA, Fenton SJ, Nance ML. Defining the role of angioembolization in pediatric isolated blunt solid organ injury. J Pediatr Surg 2020; 55 (04) 688-692
    CrossrefPubMedGoogle Scholar
  • 9 Swendiman RA, Abramov A, Fenton SJ. et al. Use of angioembolization in pediatric polytrauma patients: with blunt splenic injury angioembolization in pediatric blunt splenic injury. J Pediatr Surg 2021; 56 (11) 2045-2051
    CrossrefPubMedGoogle Scholar
  • 10 Skattum J, Loekke RJV, Titze TL. et al. Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study. Injury 2014; 45 (01) 156-159
    CrossrefPubMedGoogle Scholar
  • 11 Schimmer JAG, van der Steeg AFW, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: a systematic review. Injury 2016; 47 (03) 525-530
    CrossrefPubMedGoogle Scholar
  • 12 Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995; 38 (03) 323-324
    CrossrefPubMedGoogle Scholar
  • 13 Davies DA, Ein SH, Pearl R. et al. What is the significance of contrast “blush” in pediatric blunt splenic trauma?. J Pediatr Surg 2010; 45 (05) 916-920
    CrossrefPubMedGoogle Scholar
  • 14 McVay MR, Kokoska ER, Jackson RJ, Smith SD. Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status. J Pediatr Surg 2008; 43 (06) 1072-1076
    CrossrefPubMedGoogle Scholar
  • 15 Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD. Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. J Trauma 2010; 68 (03) 526-531
    PubMedGoogle Scholar
  • 16 Fenton SJ, Sandoval KN, Stevens AM, Scaife ER. The use of angiography in pediatric blunt abdominal trauma patients. J Trauma Acute Care Surg 2016; 81 (02) 261-265
    CrossrefPubMedGoogle Scholar
  • 17 Safavi A, Skarsgard ED, Rhee P. et al. Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis. J Pediatr Surg 2016; 51: 499-502
    CrossrefPubMedGoogle Scholar
  • 18 Coccolini F, Montori G, Catena F. et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 2017; 12 (01) 40
    CrossrefPubMedGoogle Scholar
  • 19 Ingram MCE, Siddharthan RV, Morris AD. et al. Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: is intervention necessary?. J Trauma Acute Care Surg 2016; 81: 266-270
    CrossrefPubMedGoogle Scholar
  • 20 Bansal S, Karrer FM, Hansen K, Partrick DA. Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization. Am J Surg 2015; 210 (02) 345-350
    CrossrefPubMedGoogle Scholar
  • 21 Fick AEA, Raychaudhuri P, Bear J, Roy G, Balogh Z, Kumar R. Factors predicting the need for splenectomy in children with blunt splenic trauma. ANZ J Surg 2011; 81 (10) 717-719
    CrossrefPubMedGoogle Scholar
  • 22 Loftus TJ, Croft CA, Rosenthal MD. et al. Clinical impact of a dedicated trauma hybrid operating room. J Am Coll Surg 2021; 232 (04) 560-570
    CrossrefPubMedGoogle Scholar
  • 23 Ekeh AP, Khalaf S, Ilyas S, Kauffman S, Walusimbi M, McCarthy MC. Complications arising from splenic artery embolization: a review of an 11-year experience. Am J Surg 2013; 205 (03) 250-254 , discussion 254
    CrossrefPubMedGoogle Scholar
  • 24 Ben-Ishay O, Gutierrez IM, Pennington EC, Mooney DP. Transarterial embolization in children with blunt splenic injury results in postembolization syndrome: a matched case-control study. J Trauma Acute Care Surg 2012; 73 (06) 1558-1563
    CrossrefPubMedGoogle Scholar
  • 25 Banning LBD, Meyer VM, Keupers J, Lange JFM, Pol RA, Benjamens S. Surveys in surgical education: a systematic review and reporting guideline. Eur Surg Res 2021; 62 (02) 61-67
    CrossrefPubMedGoogle Scholar