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Invited Critique
May 2012

Management of Pediatric Splenic Injury: We Agree, More or LessComment on “Less is More”

Author Affiliations

Author Affiliations: Division of Pediatric Surgery, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.

Arch Surg. 2012;147(5):441-442. doi:10.1001/archsurg.2012.344

Forty years to the month after the success of planned nonoperative management of splenic injuries was first published,1 Lee and colleagues2 provide a snapshot of how widely accepted this approach is today. The rate of splenectomy in children is now only 11%, and the odds of successful nonoperative management are not much lower in a rural hospital than in a tertiary medical center in the city. Newer treatment modalities, in particular, angiographic embolization, have helped decrease the operative rate in adults (although they have found fewer proponents among physicians who treat the pediatric population3). Because these interventions require specialized equipment and skills, it is not surprising that they are more often used in an urban setting than in small rural facilities; after all, surgical exploration remains the safe default.

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