Treat the patient, not the grade of injury: modern management of solid organ trauma in children

BACKGROUND: Trauma remains one of the leading causes of morbidity and mortality in childhood, and intra-abdominal solid organ injuries represent a major clinical challenge in pediatric trauma care. Although multiple international guidelines define diagnostic, follow-up, and treatment strategies, management decisions may still vary depending on institutional experience, patient characteristics, and imaging findings. This study aimed to evaluate the management process, treatment strategies, and clinical outcomes of pediatric patients followed for posttraumatic intra-abdominal solid organ injuries in a tertiary referral center. METHODS: Pediatric patients aged 0-18 years who were admitted to our hospital between 2014 and 2024 due to blunt or penetrating trauma and diagnosed with intra-abdominal solid organ injuries were retrospectively evaluated. Patients with gastrointestinal perforation and those who died during emergency intervention after trauma were excluded. Demographic characteristics, trauma mechanisms, injured organs, transfusion requirements, and treatment approaches were analyzed to assess current management practices. RESULTS: A total of 1043 pediatric patients were examined. Blunt trauma was present in 97% of the patients, while penetrating trauma was observed in 3%. The most common causes of blunt trauma were falls from heights and traffic accidents. Approximately 76.8% of the patients were male, with a mean age of 9.16 ± 3.4 years. The average hospital stay was 7 ± 2 days. The transfusion requirement was determined to be 8.2%, and the emergency laparotomy rate was 3.4%. Patients with stable vital signs were treated non-operatively. The most commonly injured organs were the spleen, liver, and kidney. CONCLUSIONS: In pediatric patients with solid organ injuries, treatment strategies should primarily be guided by hemodynamic stability and clinical assessment rather than injury grade alone. Conservative management in hemodynamically stable patients effectively reduces surgical intervention rates and supports favorable clinical outcomes. Careful patient selection, structured clinical follow-up, and adherence to guideline-based nonoperative management protocols may further optimize outcomes and minimize unnecessary surgical interventions in pediatric trauma care.