Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Therapeutic study, level III

中文翻译：

---

荷兰小儿脾脏损伤的处理和结果

非手术治疗（NOM）被普遍接受为外伤性小儿脾破裂的治疗方法。然而，管理方面存在相当大的差异。本研究分析了小儿脾损伤的病因学和管理的当地趋势，并评估了美国小儿外科协会 (APSA) 提出的指南在 1 级创伤中心的实施情况。回顾性评估了 2003 年至 2020 年期间入院或转至 1 级创伤中心的钝性脾损伤 (BSI) 儿科患者的图表。对有关人口统计学、损伤机制、损伤描述、相关损伤、干预和结果的信息进行了分析，并与国际文献进行了比较。确定了 130 名 BSI 患者（63.1% 为男性），平均年龄为 11.3 ± 4。0 和平均伤害严重程度评分 (ISS) 为 21.6 ± 13.7。自行车事故是最常见的创伤机制（23.1%）。64% 是多发创伤患者，25% 接受输血，31% 血液动力学不稳定。平均损伤等级为 3.0，其中 30% 的患者具有高度损伤。总共有 75% 的患者接受了 NOM，有效率为 100%。全脾切除率为6.2%。四名患者因脑损伤死亡。与低级别 BSI 患者（I-III 级）相比，高级别 BSI（IV-V 级）患者的 ISS 显着更高，卧床时间更长，并且在计算机断层扫描 (CT) 扫描中更常出现活跃的脸红. 非手术治疗是两组的主要治疗选择（分别为 76.6% 和 79.5%）。血流动力学不稳定是手术管理 (OM) 的预测因子 (p = 0.001)。更长住院时间 (LOS) 的预测因素包括伴随损伤、血流动力学不稳定和 OM（所有 p < 0.02）。BSI 分级的观察者间一致性适中，Cohens Kappa 系数为 0.493。非手术治疗已被证明是治疗低度和高度脾脏损伤的现实管理方法。手术治疗的考虑应基于血流动力学不稳定。与 APSA 指南中概述的预期卧床和住院时间相比，荷兰可以通过非手术管理减少卧床和住院时间。治疗性研究，III 级 血流动力学不稳定和 OM（所有 p < 0.02）。BSI 分级的观察者间一致性适中，Cohens Kappa 系数为 0.493。非手术治疗已被证明是治疗低度和高度脾脏损伤的现实管理方法。手术治疗的考虑应基于血流动力学不稳定。与 APSA 指南中概述的预期卧床和住院时间相比，荷兰可以通过非手术管理减少卧床和住院时间。治疗性研究，III 级 血流动力学不稳定和 OM（所有 p < 0.02）。BSI 分级的观察者间一致性适中，Cohens Kappa 系数为 0.493。非手术治疗已被证明是治疗低度和高度脾脏损伤的现实管理方法。手术治疗的考虑应基于血流动力学不稳定。与 APSA 指南中概述的预期卧床和住院时间相比，荷兰可以通过非手术管理减少卧床和住院时间。治疗性研究，III 级 手术治疗的考虑应基于血流动力学不稳定。与 APSA 指南中概述的预期卧床和住院时间相比，荷兰可以通过非手术管理减少卧床和住院时间。治疗性研究，III 级 手术治疗的考虑应基于血流动力学不稳定。与 APSA 指南中概述的预期卧床和住院时间相比，荷兰可以通过非手术管理减少卧床和住院时间。治疗性研究，III 级