Variation in paediatric splenic trauma management in adult and combined major trauma centres in England.

Abstract

AIM: Treatment options for paediatric splenic injuries include conservative management, splenic embolisation, and splenectomy. Within the UK, in addition to standalone paediatric trauma centres, adult and combined (adult and paediatric) major trauma centres (MTCs) receive traumatically injured children. We describe the treatment of paediatric splenic injuries between 2017 and 2021 in the United Kingdom adult and combined MTCs. MATERIALS AND METHODS: Data were extracted from the Trauma Audit and Research Network (TARN) for all patients <18 years old with splenic injuries admitted between 01/01/17 and 31/12/21 at adult and combined MTCs. The relationship between injury and centre type, treatment, and outcomes was assessed using chi-squared and Fisher's exact tests. RESULTS: A total of 690 children were included. The median age was 13.9 years (interquartile range: 10.9-16.1), and 78.7% (543/690) of the patients were male. A total of 92.9% (641/690) of patients suffered blunt injuries; 7.1% (49/690) suffered penetrating. Of those known, 69.5% (182/262) were treated in a combined MTC and 30.5% (80/262) at an adult MTC. Treatment included: A total of 90.4% (624/690) received conservative management, 5.5% (38/690) underwent splenic embolisation, and 4.1% (28/690) had a splenectomy. Embolisation and splenectomy rates at adult-only MTCs were 8.8% (7/80) and 10% (8/80), respectively, compared to 4.4% (8/182) and 1.6% (3/182) in combined MTCs (P = 0.002). No embolised patients required a subsequent splenectomy. The mortality rates were 8.8% (7/80) in adult and 3.3% (6/182) in combined centres (P = 0.118). CONCLUSION: Embolisation is performed more (5.5%) than splenectomy (4.1%). Combined MTCs demonstrate superior outcomes and lower intervention rates than adult-only MTCs. These findings should inform strategies to standardise paediatric trauma care within the UK.