A new survey has highlighted the findings that there is variation in application of available guidelines by general surgeons for management of children with blunt splenic trauma.
Only one in five general surgeons have been reported to be very familiar with the guidelines.
AS per current guidelines from Eastern Association for the Surgery of Children and the American Pediatric Surgery Association, it is recommend that non-operative management of blunt splenic trauma should be carried when children are hemodynamically stable.
Even so, kids in this circumstance often have splenectomy — more so in general hospitals than in children’s hospitals.
The survey was sent to a representative nationwide sample of 1379 general surgeons, all fellows of the American College of Surgeons.
375 surgeons responded, and only 18.7% said they are “very familiar” with the guidelines, although nearly all (97.4%) agreed that surgical intervention is not immediately necessary in children who are hemodynamically stable.
But there were significant differences in other attitudes. For example, about a quarter (24.5%) felt that children who are hemodynamically unstable should not receive transfusions prior to surgery. However, recent studies indicate it’s reasonable to transfuse up to 10 mL/kg before considering splenectomy.
There was also disagreement as to whether exploratory surgery is warranted for stable patients with evidence of contrast extravasation on CT scan. Nearly 35% either agreed surgery is warranted or were neutral regarding that issue.
The study has been published in archives of surgery. November issue.
Arch Surg. Posted November 2010. Abstract