The spectrum of liver and spleen injuries in children: Failure of the pediatric trauma score and clinical signs to predict isolated injuries
✍ Scribed by Richard Saladino; Dennis Lund; Gary Fleisher
- Publisher
- Elsevier Science
- Year
- 1991
- Tongue
- English
- Weight
- 444 KB
- Volume
- 20
- Category
- Article
- ISSN
- 1097-6760
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✦ Synopsis
Study objectives:
To determine whether potentially life-threatening intra-abdominal injuries occur in the absence of multisystem trauma in children, and to determine the usefulness of physical examination and a pediatric triage score in the assessment of liver and spleen injuries in children.
Design:
Retrospective study.
Setting:
Admissions to a children's hospital from october 1982 through september 1989 who were found to have liver or spleen injuries. seventy-seven patients were identified; 55 were male, 22 were female. mean age was 9 years and 3 months (+/- 56 months) with a range of 22 months to 20 years, 4 months. clinical signs were recorded and a pediatric trauma score (pts) and injury severity score (iss) were calculated for each patient.
Measurements and main results:
Fifty-four patients (70%) had a spleen injury, 18 (23%) had a liver injury, and five (7%) had both liver and spleen injuries. patients were managed without surgery in 63 of 77 cases (82%); two died. fifty-one of 77 patients (66%) received an iss of 18 or less; 26 patients (34%) received a score of more than 18. forty-four of the 51 patients (86%) with an iss of 18 or less had a normal pulse (120 or less); 48 of the 51 (94%) had a normal systolic blood pressure (90 mm hg or more). a strong negative correlation (r = -0.80; p = .001) was found between the two scores for children with multiple severe injuries (iss of more than 18); there was poor correlation (r = -0.04; p greater than .05) between the two scores for isolated liver or spleen injury (iss of 18 or less).
Conclusions:
We conclude that liver or spleen damage may be present in children without other injuries and must be considered with a high index of suspicion, and that neither the initial clinical findings nor the pts reliably predicts liver or spleen injuries in children with focal abdominal injuries.