Retrospective cohort study of paediatric splenic injuries at a major adult trauma centre in South Africa identifies areas of success and improvement

Background: Over the last 50 years, the gold standard for paediatric trauma management has grown to be non-operative management. This study reviews a South African experience with paediatric splenic trauma in order to benchmark this against the international standard and to identify discrepancies in access to care and in surgical outcomes. Methods: This was a retrospective study conducted at a major trauma centre in South Africa. All children less than 18 years of age who were admitted to our trauma centre following trauma between December 2012 and October 2020 were identified and all those who sustained splenic trauma were reviewed. Results: Of the 66 patients reviewed, 48 (72%) were male, and the median age was 12 years (0-18 years). Thirty-three (51%) were of rural origin and 61 (93%) sustained blunt trauma. Only eight (12%) had an isolated splenic injury, while the remaining 58 (88%) had other associated injuries. Forty-five patients (68%) were managed non-operatively whilst the remainder were subjected to laparotomy. Five (7%) required a splenectomy and one required angio-embolisation. Twenty-six patients (39%) required intensive care unit (ICU) admission: 15 (37%) in the non-operative cohort required ICU admission and eight (40%) in the laparotomy group required ICU admission. Twenty-eight (42%) patients required ventilatory support. Median length of stay was 5.5 days. Four (6%) patients died. Conclusions: Although non-operative management of paediatric splenic trauma can be undertaken successfully by adult trauma surgeons in a middle-income country such as South Africa, there remains room for improvement. To achieve splenic salvage rates comparable to those in dedicated paediatric trauma centres in high-income countries will require systematic quality improvement programmes.