Introduction

Trauma remains the leading cause of childhood death in the United States,[1] with the abdomen being the third most commonly injured anatomic region in pediatric trauma.[2] It is estimated that blunt liver and/or splenic injuries represent 82% of pediatric solid organ injuries.[3] Given the robust vascular supply to the liver and the spleen, significant injury to either or both organ(s) can result in life-threatening hemorrhage. However, evidence-based practice over the past decade has demonstrated that the vast majority of liver and spleen injuries can be managed nonoperatively. A recent ATOMAC+ prospective multicenter study of 1,029 children showed that of the 713 (69%) children who had no clinical evidence of significant bleeding on arrival, none of these initially stable patients required surgery for liver or splenic bleeding.[4] Nonoperative management (NOM) of blunt liver and spleen injury is highly effective and has become the standard of care. The establishment of treatment algorithms supporting nonoperative management has led to decreases in periods of bedrest, overall length of stay, and unnecessary resource utilization.[5]

Content in this module is referenced in SCOREAbdominal Trauma overview