Transarterial embolization in children with blunt splenic injury results in postembolization syndrome: a matched case-control study.

Abstract

Postembolization syndrome (PES) has been reported in adults following transarterial embolization (TAE) for blunt splenic injury (BSI), but not in children. We report the incidence of PES in a group of children who underwent TAE. Children who underwent TAE were identified, and each case of TAE was matched by grade of splenic injury and Injury Severity Score with four similar patients who did not. Data collected included demographics, vital signs, laboratory data, the presence of contrast blush, the hemoperitoneum score, hospital course, and outcome. The subgroup with a high hemoperitoneum score was analyzed separately. Within 12 years, of 448 patients diagnosed as having BSI, 11 (2.5%) underwent TAE. Children undergoing TAE had lower preprocedure hemoglobin (10.4 vs. 11.8 g/dL, p = 0.02) and platelet counts (194.8 vs. 267.9 cells/μL, p = 0.006) and received more packed red blood cells (3.1 vs. 0.11 units, p < 0.001) and fresh-frozen plasma (0.24 vs. 0 units, p = 0.04). Postprocedure hemoglobin and platelet counts were not different, but white blood cell count was elevated in the TAE group (13.5 vs. 9.1 cells/μL, p = 0.04). The TAE group had longer intensive care unit (2.82 vs. 1.18 days, p < 0.001) and hospital (8.6 vs. 5.2 days, p < 0.001) stays and took longer to tolerate a full diet (5.4 vs. 1.6 days, p < 0.001). These relationships persisted when only children with high hemoperitoneum scores were considered.PES occurred in 90.1% of those who underwent TAE and in 2.3% of those who did not. Late complications were noted in 27.3% of the TAE group versus none and correlated with the length of hospital stay (10.67 vs. 5.63 days, p < 0.001). TAE is a valuable tool in the management of BSI in children but leads to PES in most children. PES is self-limited but is associated with longer hospital stays and more complications and readmissions, with no effect on operative rate or mortality. Prognostic study, level III; therapeutic study, level IV.