Risk of hemorrhage and appropriate use of blood transfusions in pediatric blunt splenic injuries

Objective: To define changes in hematocrit (Hct) and the indications for blood transfusion in pediatric blunt splenic injury. Design: Retrospective case series. Materials and Methods: All children with blunt splenic injuries from 1990 to 1995 were studied (n = 74). Transfusion practices were reviewed for the whole group. Thirty children with isolated splenic injuries who were not transfused were analyzed to document Hct changes (mean ± 95% confidence intervals). Measurements and Results: The Hct at presentation was 37 ± 2%, which rapidly dropped to 31 ± 2% (p < 0.05) within 24 hours. After remaining stable at that level for the next 5 days, the Hct rose to 33 ± 4% on day 6 (p = not significant), 35 ± 4 % on day 7 (p = not significant), and 38 ± 2% (p = not significant) on day 13 ± 3. Fifteen children received transfusions, all but one of whom had suffered multiple injuries. The transfusion rate declined from 38% of children in 1990 to 10% in 1995. Conclusions: After the initial drop within the first 24 hours, the Hct remains stable and rises with time to reach the baseline by day 6. Transfusion rates have declined over time, and transfusions are now used almost exclusively in severely injured children with multiple injuries.