Wu Wang, Haiyan Lei, Wenhan Zhang, Wenhai Li, Hongqiang Bian, Jun Yang
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引用次数: 0
Abstract
Introduction: Nonoperative management (NOM) is recognized as a viable treatment for pediatric closed splenic trauma. However, clinical guidelines are applied inconsistently, resulting in different treatment strategies in different regions. This study aimed to investigate the independent risk factors influencing the length of stay in pediatric closed splenic injuries and to analyze the key determinants in the choice of surgical treatment to optimize inpatient management and patient care and improve outcomes.
Methods: A retrospective evaluation of medical records of pediatric patients with blunt splenic injury (BSI) admitted to Wuhan Children's Hospital from 2020 to 2024 was conducted. The dataset included demographics, mechanism of injury, injury grade, associated injuries, therapeutic measures, and outcomes, which were subjected to statistical analysis. Factors influencing length of hospital stay and treatment regimen were also analyzed.
Results: A total of 88.5% of patients underwent NOM, with 11% requiring splenic embolization due to hemodynamic instability or arterial hemorrhage. Surgery was required in 11.5% of patients, primarily for combined gastrointestinal perforation, or peritonitis. One patient died due to brain injury. Trauma scores and transfusion requirements were higher in the surgical group (37.7 ± 16.1 vs. 17.2 ± 13.1, p < 0.001; 21.7% vs. 100%, p < 0.001). Multivariate logistic regression showed that gastrointestinal complications significantly influenced the decision to operate (p = 0.0087). A generalized additive model showed a corresponding increase in length of stay with increasing injury severity, with the curve flattening in the mid to high ISS range (40-60).
Conclusion: NOM remains an effective and preferred treatment strategy for pediatric BSI, particularly in the setting of stable hemodynamic parameters. This approach reduces the need for surgical intervention and associated complications while preserving splenic function. The study highlights that gastrointestinal complications are important determinants of surgical management. Further research into long-term outcomes and advancements in conservative management are needed.
导言：非手术治疗（NOM）被认为是治疗小儿闭合性脾脏创伤的可行方法。然而，临床指南的应用并不一致，导致不同地区的治疗策略也不尽相同。本研究旨在调查影响小儿闭合性脾损伤住院时间的独立风险因素，并分析选择手术治疗的关键决定因素，以优化住院管理和患者护理，改善预后：对武汉市儿童医院2020年至2024年收治的小儿钝性脾损伤（BSI）患者的病历进行回顾性评估。数据集包括人口统计学、损伤机制、损伤等级、相关损伤、治疗措施和结果，并进行了统计分析。此外，还对住院时间和治疗方案的影响因素进行了分析：共有88.5%的患者接受了NOM治疗，其中11%的患者因血流动力学不稳定或动脉出血而需要进行脾栓塞治疗。11.5%的患者需要进行手术，主要是因为合并消化道穿孔或腹膜炎。一名患者因脑损伤死亡。手术组的创伤评分和输血需求更高（37.7 ± 16.1 vs. 17.2 ± 13.1，p p = 0.0087）。广义相加模型显示，随着受伤严重程度的增加，住院时间也相应增加，曲线在ISS中高范围（40-60）趋于平缓：结论：NOM仍是治疗小儿BSI的有效和首选策略，尤其是在血流动力学参数稳定的情况下。这种方法在保留脾脏功能的同时，减少了手术干预和相关并发症的需求。研究强调，胃肠道并发症是手术治疗的重要决定因素。我们需要进一步研究保守治疗的长期效果和进展。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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