In children who sustain multiple trauma, 25% have serious intraabdominal injuries. Which of the following statement(s) is/are true concerning blunt abdominal trauma in children?

c. Splenic salvage can be achieved in 90% to 100% of patients

d. The indications for laparotomy for splenic injury include refractory hypotension or transfusion requirement in excess of 50% of blood volume within the first 24 hours

Diagnostic peritoneal lavage is a rapid and sensitive test for the presence of intraabdominal hemorrhage. In general, however, peritoneal lavage has a limited role in the care of pediatric patients as it provides confirmation of a finding, hemoperitoneum, that does not mandate operation. Unlike adults, 95% of pediatric trauma patients are hemodynamically stable on admission. The single most useful diagnostic maneuver is a CT scan, which delineates solid visceral injuries with a high degree of both sensitivity and specificity. The spleen and liver are injured with about equal frequency in children sustaining blunt trauma, and together these two target organs account for about 75% of childhood abdominal injuries.

Experience at virtually every major children’s trauma center in the world supports the safety and efficacy of nonoperative management of children with splenic ruptures. Most series report splenic salvage in 90% to 100% of children. Although therapy must be individualized, the general guidelines are that operation is not indicated until there is refractory hypotension or a transfusion requirement in excess of 50% of blood volume in the first 24 hours. In reality, few patients approach this, and transfusion practices are such that only 10% to 20% of patients with isolated splenic injuries require blood transfusion at all. The management of liver injuries in pediatric patients has also changed since the advent of routine abdominal CT scan for blunt trauma. Several reports describe successful nonoperative treatment of liver injuries detected radiologically in children. This approach is applicable in most children, with a success rate of 90% and transfusion requirements similar to those patients with ruptured spleens.