ARTICLE IN PRESSlournal of Pediatric Surgery xxx (xxxx)xxxContents lists available at ScienceDirectJournal of Pediatric Surgeryjournal homepage:www.sciencedirect.com/journal/ELSEVIERjournal-of-pediatric-surgeryUpdated APSA Guidelines for the Management of Blunt Liver andSpleen InjuriesRegan F.Williams,Harsh Grewal Ramin Jamshidi,Bindi Naik-MathuriaMitchell Price,Robert T.Russell Adam Vogel David M.Notrica,Steven Stylianosh,John PettyLe Bonheur Children's Hospital,49 North Dunlap Avenue,Second Floor,Memphis,Tn 38105.USADrexel University College f Medicine,St Christopher's Children's Hospital 160 East Erie Avenue,Philadelphia.PA.19134.USAPhoenix Children's Hospital 1919 E Thomas Road,Phoenix,Az.85016.USAUniversity of Texas Medical Branch,712 Texas Avenue,Galveston,TX 77555.USADivision of Pediatric Surgery-Staten Island University Hospital/CCMC/Northwell Health.378 Seaview Ave.Lower Level Staten Island.NY.10305.USAChildren's of Alabama,1600 7th Avenue South,Lowder Bldg.Suite 300,Birmingham,AL 35233.USADepartment of Surgery.Texas Children's Hospital and Baylor College of Medicine,6701 Fannin Street,Suite 1210.Houston,TX 77030.USADivsion of Pediatric Surgery.Colmbia University Vagelos College of Physicians SurgeonsSection of Pediatric Surgery.Wake Forest University School of Medicine,Medical Center Boulevard.Winston-Salem,NC.27157.USAARTICLE INFOABSTRACTArticle history:Bockground:Non-operative management of blunt liver and spleen injuries was championed initially inReceived 25 October 2022children with the first management guideline published in 2000 by the American Pediatric SurgicalReceived in revised formAssociation (APSA).Multiple articles have expanded on the original guidelines and additional therapy8 March 2023Accepted 10 March 2023has been investigated to improve care for these patients.Based on a literature review and currentconsensus,the management guidelines for the treatment of blunt liver and spleen injuries are presented.Methods:A recent literature review by the APSA Outcomes committee [2]was utilized as the basis forKeywords:Pediatric traumathe guideline recommendations.A task force was assembled from the APSA Committee on Trauma toBlunt traumareview the original guidelines,the literature reported by the Outcomes Committee and then to developSolid organ injuryan easy to implement guideline.Treatment guidelinesResults:The updated guidelines for the management of blunt liver and spleen injuries are divided into 4sections:Admission,Procedures,Set Free and Aftercare.Admission to the intensive care unit is based onabnormal vital signs after resuscitation with stable patients admitted to the ward with minimal restrictions.Procedure recommendations include transfusions for low hemoglobin (<7 mg/dL)or signs of ongoingbleeding Angioembolization and operative exploration is limited to those patients with clinical signs ofcontinued bleeding after resuscitation.Discharge is based on clinical condition and not grade of injury.Activity restrictions r
