Nonoperative management of liver and spleen injuries in pediatric trauma patients

Trauma is the leading cause of mortality among teenagers in Korea and across all pediatric age groups other than infants in the United States.Brain injuries constitute the most common cause of trauma-related death; however, hemorrhage due to thoracoabdominal injuries accounts for a significantly higher proportion of preventable deaths than traumatic brain injury.Therefore, the management of abdominal injuries is as important as that of traumatic brain injury in trauma care.The management of liver and spleen (LS) injuries has increasingly shifted toward nonoperative management, for which an accurate assessment of the patient's physiological status and appropriate transfusion are critically important.The Shock Index Pediatric Adjusted is a useful tool for evaluating shock status based on the patient's age and can guide transfusion decisions.Although most LS injuries are successfully managed nonoperatively, nonoperative management requires a timely decision to transition to surgical intervention when necessary.This article aims to present current clinical guidelines and landmark studies, and to discuss key considerations in the management of LS injuries in pediatric patients.