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  • Outcomes of Pediatric Blunt Liver and Spleen Injury in 1029 patients using the ATOMAC+ Pediatric Trauma Research Network Guideline. Journal of pediatric surgery Notrica, D. M., Maxson, T., Stottlemyre, R. L., Cohen, A. S., Bundrant, N., Lawson, K. A., Eubanks, J. W., Ryan, M., Letton, R. W., Bhatia, A., Wyrick, D., St Peter, S. D., Leys, C., Ponsky, T., Williams, R. F., Johnson, J. J. 2026: 163107

    Abstract

    BACKGROUND: The ATOMAC+ guideline is an evidence-based guideline for management of pediatric blunt liver and/or spleen injury (BLSI) based on clinical signs of bleeding on arrival.METHODS: A prospective multi-institutional study of children aged ≤18 years with BLSI was conducted at 10 pediatric trauma centers. Unstable patients without computed tomography were added retrospectively. Demographic data, interventions, and outcomes were analyzed.RESULTS: Of 1,029 children (median age 10.2 years) with BLSI, 713 (69%) had no signs of clinically significant bleeding upon arrival, and no initially stable patients required surgery for bleeding; 13 (1.8%) required abdominal surgery for other reasons. Of 316 patients with clinical signs of recent bleeding or ongoing bleeding on arrival, 10 patients died in the ED and 17 non-responders underwent surgery directly. Among 168 patients responding initially to transfusion, 22 underwent angiography and 60 went to surgery (9 after angiography). Of the 44 stabilized patients who received >40mL/kg blood products, only 5 (11%) survived without intervention. Additionally, 37 (32%) transfused patients not meeting this threshold also underwent abdominal intervention. Overall mortality was 3.4% including 21% of 42 patients transfused >40mL/kg or 4 units of blood.CONCLUSION: The frequency of laparotomy or laparoscopy in children with BLSI was 8.2%. Children with no clinical signs of bleeding upon arrival did not later bleed, but 1.6% of these patients ultimately required abdominal surgery for other injuries. Transfusion >40mL/kg was strongly associated with intervention or death, but a substantial number of children who received less blood also required intervention.

    View details for DOI 10.1016/j.jpedsurg.2026.163107

    View details for PubMedID 41887567