Updated APSA Blunt Liver/Spleen Injury Guidelines 2019
Guideline · Apr 2019 · 1 min read
In brief
In brief
The 2019 APSA guidelines update evidence-based recommendations for nonoperative management of blunt liver and spleen injuries in children. Key updates address the limited utility of serial hemoglobin monitoring, the role of CT contrast blush in predicting intervention need, and refined bedrest protocols based on injury grade.
- Repeat hemoglobin/hematocrit monitoring after blunt solid organ injury in children has limited clinical utility
- Admission hematocrit is a key predictor for transfusion need in pediatric blunt trauma patients
- CT contrast blush in pediatric hepatic/splenic injury does not automatically mandate intervention
- APSA ATOMAC guidelines support non-operative management for most pediatric blunt liver and spleen injuries
- Bedrest protocols for pediatric solid organ injury management have been prospectively validated
Written by the GCMD Library team from the guideline.
Updated APSA Blunt Liver/Spleen Injury Guidelines 2019
References
• Acker et al. Lack of utility of repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children. J Trauma Acute Care Surg 2015. 79 (6): 991-994.
• Gates 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 Jan 31. epub
• Golden et al. Admission hematocrit predicts the need for transfusion secondary to hemorrhage in pediatric blunt trauma patients. J Trauma Acute Care Surg 2015. 79 (4):555-562.
• Ingram et al. Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: Is intervention necessary? J Trauma Acute Care 2016. Surg 81 (2):266-270.
• Notrica 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 (4): 683-693
• St Peter SD et al. Follow up of prospective evaluation of bedrest protocol in the management of blunt spleen and liver injury in children. Journal of Pediatric Surgery (2013) 48, 2437–2441.
April 16, 2019 – Approved by APSA Board of Governors
Statements in this guideline
Repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children lacks utility.
Admission hematocrit predicts the need for transfusion secondary to hemorrhage in pediatric blunt trauma patients.
Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma does not necessarily require intervention.
Non-operative management of blunt liver and spleen injury in children has been evaluated using the ATOMAC guideline with GRADE methodology.
A bedrest protocol has been prospectively evaluated in the management of blunt spleen and liver injury in children.