ORIGINAL ARTICLE Conservative approach to the treatment of injured liver and spleen in children: association with reduced mortality Elad Feigin Æ Limor Aharonson-Daniel Æ Bela Savitsky Æ Ran Steinberg Æ Dragan Kravarusic Æ Michael Stein Æ Kobi Peleg Æ Enrique Freud Accepted: 28 May 2009 / Published online: 11 June 2009 Ó Springer-Verlag 2009 Abstract Background Previous analyses of the safety of the con- servative versus the operative approach to the treatment of liver and spleen blunt injuries in children often failed to account for differences in quality of care and expertise among dedicated pediatric trauma center, non-pediatric centers, centers without trauma units, and non-trauma centers. To eliminate this potential bias, the present study examined changes in the rate of surgery and their impact on outcome within the same medical centers over time. Methods The Israel Trauma Registry was searched for patients \ 18 years who were treated for non-penetrating liver or spleen injuries from 1998 to 2004. Patients were grouped by period, 1998–2000 and 2001– 2004, and compared for type of injury, severity of injury, type of treatment, and inpatient mortality. Results The earlier period (1998–2000) was characterized by a significantly higher rate of operations compared with the later period (2001–2004) (P = 0.001) and higher in-hospital mortality (P = 0.04). Injury severity scores, type of organs injured, and accompanying injuries were similarly distributed in the two groups. Conclusions Despite the similarity in the severity and characteristics of the intraabdominal injuries in 1998–2000 and in 2001–2004, the proportion of children treated con- servatively increased over time, concomitant with a sig- nificant drop in inpatient mortality. We attribute this shift over a relatively short interval to increased experience and greater acceptance of conservative management in this setting. Keywords Blunt injury Á Liver Á Mortality Á Non-operative Á Spleen Introduction The standard of care for isolated blunt intraperitoneal solid organ injuries in children has undergone major changes in the last five decades [1]. The non-operative approach is now universally accepted, with reported success rates of more than 90% [2, 3]. To standardize the optimal care, the American Pediatric Surgical Association (APSA) recom- mended evidence-based guidelines, which were prospec- tively validated [4]. Their application resulted in excellent outcome with reduced utilization of medical resources [4–7]. The drop in the use of surgical interventions in cases of pediatric trauma has given rise to a debate on the role of the pediatric surgeon, and there are still wide variations among trauma surgeons regarding the level of conservatism exercised [3–6, 8]. Some studies reported that when a pediatric surgeon was involved in patient care, the rate of surgery decreased significantly [3, 9, 10]. This problem is E. Feigin (&) Á R. Steinberg Á D. Kravarusic Á E. Freud Department of Pediatric Surgery, Schneider Children’s Medical Center of Israel, 49202 Petah Tiqwa, Israel e-mail: eladf@clalit.org.il L. Aharonson-Daniel Á B. Savitsky Á K. Peleg Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel M. Stein Trauma Unit, Rabin Medical Center, Petah Tiqwa, Israel E. Feigin Á L. Aharonson-Daniel Á B. Savitsky Á R. Steinberg Á D. Kravarusic Á M. Stein Á K. Peleg Á E. Freud Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 123 Pediatr Surg Int (2009) 25:583–586 DOI 10.1007/s00383-009-2398-7