Prevalence of contrast extravasation and embolization in blunt liver and spleen injuries at a single pediatric trauma center.

PURPOSE OF THE STUDY: In 2019, the APSA guidelines for the management of solid organ injuries in children recommended limiting embolization to patients with evidence of ongoing hemorrhage. We sought to identify patients who presented to our institution with contrast extravasation (CE) on initial imaging, determine the proportion who required embolization, and describe their associated outcomes.

METHODS

A retrospective chart review of all patients with blunt liver and/or spleen injuries (BLSI) treated at our institution between 2014 and 2023 was performed.

RESULTS

We identified 219 patients and included 177 patients in our analysis. The majority sustained spleen injuries (64.5 %), while the remainder suffered from liver (28.2 %) or combined liver-spleen injuries (7.3 %). A total of 144 patients had a computed tomography (CT) scan (82.4 %) while the remainder only underwent a formal ultrasound. Twelve patients had positive CE (8.3 %), 4 had equivocal CE (2.8 %) due to BLSI, and 2 had CE from kidney injuries (1.4 %). No surgical intervention was performed for bleeding. Only 4 patients required an embolization (2.3 % of all study patients, and 25 % of those with positive/equivocal CE); all had positive or equivocal CE and required transfusions. Notably, two patients underwent an angiogram for CE on CT, but no bleeding was identified during the procedure. No patients required an embolization after hospital discharge. Five patients were readmitted for complications (2.8 %), although none were related to bleeding.

CONCLUSION

Our experience supports limiting embolization to patients showing signs of hemodynamic instability after adequate resuscitation instead of systemically taking all pediatric patients with CE after BLSI for embolization.

LEVEL OF EVIDENCE: Level II - retrospective cohort.