A comparison of adult and pediatric guidelines for the management of blunt splenic trauma.

Abstract

The management of blunt splenic trauma varies between children and adults, with disparate rates of splenectomy and angioembolization. This practice variation can be explained by some of the most recently published guidelines by the American Pediatric Surgical Association (APSA) and the Western Trauma Association (WTA). This narrative review compares these guidelines, and the evidence behind them. A comparison of the guidelines published in 2023 by WTA and APSA was undertaken, supplemented by recommendations in the 2016 WTA & 2015 ATOMAC guidelines. The publications that underpinned the guidelines were also examined. The recommendations from each guideline were summarized and similarities & differences noted, focusing on initial evaluation and resuscitation, the role of imaging, management strategies, hospitalization and follow up. While both guidelines highlight standardized initial resuscitation, subsequent management of both stable and unstable patients is different: guided by CT findings and hemodynamic status in adults and hemodynamic status alone in children. In stable adults, the grade of injury dictates the use of angioembolization, a therapeutic intervention rarely used in children. Differences with regards to ICU admission, follow up investigations and the use of thromoprophylaxis, also underscore the different management strategies in each cohort. It is hoped that this comparison lays the foundation for further exploration of how a unified guideline may be developed, acknowledging the need for nuanced care and resource optimization.