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Spleen 27%
Kidney 27%
Liver 15%
Pancreas 2%
Splenic Trauma
Diagnosis:
FAST
Focused Abdominal
Sonography for
Trauma
Operator Dependent
15% false-negative
May miss up to 25% of
liver and spleen injuries Fluid in the subphrenic space and
Compared to CT only splenorenal recess can be detected.
63% sensitive for The image shown demonstrates blood
detecting free fluid (arrow) between the spleen (S) and
diaphragm (D).
Splenic Trauma
Diagnosis:
CT with IV contrast
Noninvasive, highly
accurate, easily
identifies and
quantifies extent of
injury, for stable
patient only
A: Hemoperitoneum with a liver
laceration (arrow) and a
shattered spleen is seen.
AAST Splenic Injury Scale
Treatment
1. Nonoperative failure rate 2%
2. Risks for increased nonoperative failure
rate
More than one solid organ injury
Spleen Grade 5
APSA Guidelines
APSA guidelines for hemodynamically stable children with isolated
spleen or liver injury
CT GRADE I II III IV
Days in ICU None None None 1 day
Hospital stay 2 days 3 days 4 days 5 days
Predischarge None None None None
imaging
Postdischarge None None None None
imaging
Activity 3 weeks 4 weeks 5 weeks 6 weeks
restrictions
From Stylianos S, and APSA Trauma Committee: Evidence-based guidelines for resource
utilization in children with isolated spleen or liver injury.