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Splenic Laceration
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Activity restrictions have moved towards shorter duration; previously grade 4 spleen lacerations required 12 weeks or longer out of activity. Update Course Rewind: Updates in Solid Organ Injury Management 2023 · 2:45
Update Course 2023 - Rapid Updates in Pediatric Trauma
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This session is on rapid updates in pediatric trauma with Drs. Katie Russell & Meera Kotagal.
The 11th Annual Pediatric Surgery Update Course was held on August 29, 2023 in Cleveland, Ohio and was livestreamed to a global audience. Th
video46:42 · Oct 2023
Update Course Rewind: Updates in Solid Organ Injury Management 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Updates in Solid Organ Injury Management". Joining the
video · Mar 2024
The Future of Surgical Education: A King, an Ox, & Elon Musk
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Update Course Rewind: Updates in Solid Organ Injury Management 2023
APSA guidelines include four basic categories for solid organ injury management: where patients should be admitted, procedures, when to discharge them, and what to do after discharge.
guideline1:45 ↗
In kids, the data doesn't support the need for angioembolization, even if you see active arterial extravasation on CT.
clinical2:10 ↗
APSA guidelines indicate discharge when patients are clinically doing well, with no indication for repeat imaging after discharge.
guideline2:25 ↗
Activity restrictions have moved towards shorter duration; previously grade 4 spleen lacerations required 12 weeks or longer out of activity.
guideline2:45 ↗
Cincinnati Children's Hospital guideline states only hemodynamically abnormal patients go to the ICU.
guideline3:44 ↗
Cincinnati has started discharging isolated grade 1 or 2 splenic injuries from the emergency department.
clinical3:44 ↗
In a study of grade 1 and 2 injuries with no other major organ injured, not a single patient got an intervention during hospitalization, including transfusion.
epidemiological4:00 ↗
Grade 1-2 injuries are discharged from ED if patients are watched for 4 hours and able to tolerate a PO challenge.
clinical4:00 ↗
CT scanning serves two purposes: making a diagnosis overall and determining appropriate discharge activity restrictions, which differ between splenic laceration and small bowel contusion.
clinical4:55 ↗
In the blunt abdominal trauma guideline at Cincinnati, not all patients are scanned; AST and lipase are used to decide who needs a scan.
clinical5:37 ↗
Standardized discharge instructions are created and given to all patients in collaboration with the emergency department.
clinical6:42 ↗
Every patient discharged with solid organ injury is seen in trauma clinic within the week to ensure the child is doing well and to provide continued counseling about activity restrictions.
clinical6:42 ↗
At the Utah practice, 80% of pediatric trauma patients are transfers and most have already had a CBC at the referring hospital.
epidemiological7:17 ↗
For hemodynamically normal children with solid organ injury going to the floor, CBC is not repeated.
clinical7:39 ↗
Data suggests that patients more likely to fail non-operative management have an initial hemoglobin less than 9.25.
epidemiological8:00 ↗
Cincinnati protocol: if initial hemoglobin is less than 9.25, patient gets one repeat hemoglobin; if greater than 9.25, no repeats unless clinically indicated.
clinical8:00 ↗
Contrast-enhanced ultrasound for grading solid organ injuries is not done routinely because radiologists and ultrasonographers comfortable with the technique are not available at 2:00 in the morning.
clinical8:24 ↗
Contrast-enhanced ultrasound has not been found to be very reliable yet as an alternative to CT for solid organ injury grading.
opinion8:24 ↗
In resource-constrained settings like Uganda, grade 4 splenic laceration patients would be placed in ICU due to limited monitoring capacity on the floor, where there may not be monitors and minimal staff.
clinical0:53 ↗
Management of splenic lacerations is a reflection of available resources; ICU admission decisions differ between resource-constrained and well-resourced settings.
opinion0:53 ↗
Update Course 2023 - Rapid Updates in Pediatric Trauma
APSA guidelines recommend that hemodynamically normal patients with solid organ injuries should be admitted to the floor rather than ICU, regardless of injury grade.
Host summaryMeera Kotagal summarizes what Dr. Katie Russell said — not the host's own clinical position3:57 ↗
APSA guidelines recommend activity restrictions of grade plus 2 weeks for solid organ injuries, which is shorter than the previous practice of 12 weeks for grade 4 injuries.
Host summaryMeera Kotagal summarizes what Dr. Katie Russell said — not the host's own clinical position5:44 ↗
Cincinnati Children's is now discharging isolated grade 1 and 2 solid organ injuries from the emergency department after 4 hours of observation if patients can tolerate oral intake.
clinicalMeera Kotagal6:39 ↗
In Chris Strack's study of grade 1 and 2 solid organ injuries with no other major organ injury, not a single patient required intervention including transfusion during hospitalization.
Host summaryMeera Kotagal summarizes what Dr. Katie Russell said — not the host's own clinical position7:13 ↗
Patients who are more likely to fail non-operative management of solid organ injury have an initial hemoglobin less than 9.25 g/dL.
Host summaryMeera Kotagal summarizes what Dr. Katie Russell said — not the host's own clinical position13:23 ↗
Cincinnati Children's protocol eliminates repeat hemoglobin checks in solid organ injury patients with initial hemoglobin greater than 9.25 g/dL unless there is clinical concern.
clinicalMeera Kotagal13:34 ↗
Bed rest is only used for ICU-level patients who are hemodynamically abnormal, at least overnight until hemodynamics stabilize; all other solid organ injury patients do not require bed rest.
clinicalMeera Kotagal15:36 ↗
The definition of massive transfusion in pediatrics is 40 mL/kg or more of any blood product over 24 hours.
Host summaryKatie Russell summarizes what Dr. Meera Kotagal said — not the host's own clinical position24:40 ↗
New data from the blood investigators (Maddock trial group) suggests activating massive transfusion protocol after 20 mL/kg of blood within an hour if the patient remains unstable.
Host summaryKatie Russell summarizes what Dr. Meera Kotagal said — not the host's own clinical position26:07 ↗
Balanced resuscitation with more FFP (closer to 1:1:1 ratio) is associated with lower mortality in pediatric massive transfusion.
Host summaryKatie Russell summarizes what Dr. Meera Kotagal said — not the host's own clinical position25:26 ↗
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