From
StayCurrentMD
Solid Organ Injury Rapid Fire Session: Update Course 2015
With Dr. Kenneth Azarow · hosted by Dr. Todd Ponsky
Chapter 1 of 3 · Case-Based Learning
Grade 5 case
Case presentation: Grade 5 splenic injury managed non-operatively
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
A 15-year-old sustained a grade 5 splenic injury with CT blush and blood around the liver after collision during baseball game, with vital signs of 125/80 and pulse 85
Current management trend is to treat based on hemodynamics rather than CT grade for isolated spleen and liver injuries
Hemodynamics-based management allows patients to be discharged from hospital much quicker than traditional protocols
Hemodynamically stable is defined as normal blood pressure, normal respiratory rate, not in extremis
Tachycardia determination requires pain control to distinguish whether it is due to pain, overlying broken rib, or blood in abdomen
Patients with normal vital signs and no tachycardia can be discharged in less than 24 hours for less severe injuries
The grade 5 splenic injury case was discharged within 48 hours, which would not have happened even the previous year without the algorithm
Early discharge protocols are not used for patients from across the state; they are reserved for local patients whose parents can return quickly if needed
Post-discharge activity restriction follows grade plus 2 weeks formula
Rebleeds have been observed in solid organ injuries, justifying activity restrictions
Once a stable clot forms for about 3 weeks, it is probably more stable than the remaining spleen
Future practice may involve more aggressive return to normal activity, potentially before contact sports, once early discharge becomes common practice
Large pseudoaneurysms should probably be coiled
Pseudoaneurysms can be managed with stenting or coiling by interventional radiologists or vascular surgeons
Growing pseudoaneurysms require intervention
Small pseudoaneurysms can be followed with observation
In adults, 2 centimeters is the cutoff for mesenteric vessel pseudoaneurysms at which intervention is considered, but the threshold for pediatric patients is unknown
The true denominator of how many children have pseudoaneurysms is unknown because they are not getting imaged
Hilar vessel injuries can be seen on initial CT scans
Most places around the country have aggressive discharge protocols for solid organ injuries
Literature is fairly clear that patients do not need to be reimaged after solid organ injury