Management of Pediatric Splenic Trauma: A 15-Year Single-Center Experience and a Comparative Analysis of Care Models

Abstract Background Nonoperative management (NOM) is the standard for pediatric splenic trauma, yet care disparities persist. This study analyzed NOM outcomes in a specialized pediatric trauma center and modeled strategies in settings without interventional radiology (IR). Methods A retrospective study of pediatric patients (0–14 years) with blunt splenic injury (2010–2024) was conducted. Actual splenectomy rates (Group 1: specialized center) were compared with hypothetical models without IR using pediatric (Group 2) and adult (Group 3) guidelines. Statistical analysis used Fisher’s exact test for categorical comparisons and Mann–Whitney U test for continuous variables (p < 0.05). Results Forty-four patients were included. The splenectomy rate for Group 1 was 11.4% (5/44), compared to a predicted 15.9% (7/44) for Group 2 and 31.8% (14/44) for Group 3. Differences were not statistically significant after Bonferroni correction. Factors most strongly associated with splenectomy were hemodynamic instability ( p < 0.0001), a higher AAST injury grade ( p < 0.0001), and a significantly higher Injury Severity Score (ISS) (median 43 vs. 13, p = 0.0002). This higher baseline severity was reflected in outcomes, with the splenectomy group requiring significantly longer hospitalization (median 46 vs. 15 days, p = 0.0031). One death occurred (severe traumatic brain injury). Conclusion Our study highlights that hemodynamic instability, high-grade anatomical injury, and overall trauma severity (ISS) are primary factors associated with splenectomy. Our models quantify the critical role of specialized pediatric trauma centers with available interventional radiology in maximizing spleen salvage. Findings support the centralization of care to minimize unnecessary splenectomies.