Updated APSA Guidelines for the Management of Blunt Liver and Spleen Injuries

Topic overview

New article you should know about from the Journal of Pediatric Surgery by Dr. Cecilia Gigena

"Updated APSA Guidelines for the Management of Blunt Liver and Spleen Injuries" 

Authors: Regan F. Williams, Harsh Grewal, Ramin Jamshidi, Bindi Naik-Mathuria, Mitchell Price, Robert T. Russell, Adam Vogel, David M. Notrica, Steven Stylianos, John Petty

Full article: https://gcmd.co/3N792cP

Background

Non-operative management of blunt liver and spleen injuries was championed initially in children with the first management guideline published in 2000 by the American Pediatric Surgical Association (APSA). Multiple articles have expanded on the original guidelines and additional therapy has been investigated to improve care for these patients. Based on a literature review and current consensus, the management guidelines for the treatment of blunt liver and spleen injuries are presented.

Methods

A recent literature review by the APSA Outcomes committee [2] was utilized as the basis for the guideline recommendations. A task force was assembled from the APSA Committee on Trauma to review the original guidelines, the literature reported by the Outcomes Committee and then to develop an easy to implement guideline.

Results

The updated guidelines for the management of blunt liver and spleen injuries are divided into 4 sections: Admission, Procedures, Set Free and Aftercare. Admission to the intensive care unit is based on abnormal vital signs after resuscitation with stable patients admitted to the ward with minimal restrictions. Procedure recommendations include transfusions for low hemoglobin (<7 mg/dL) or signs of ongoing bleeding. Angioembolization and operative exploration is limited to those patients with clinical signs of continued bleeding after resuscitation. Discharge is based on clinical condition and not grade of injury. Activity restrictions remain the same while follow-up imaging is only indicated for symptomatic patients.

Conclusion

The updated APSA guidelines for the management of blunt liver and spleen injuries present an easy-to-follow management strategy for children.

Intended audience: Healthcare professionals and clinicians.