An Opportunity for Continued Improvement: Evaluating the Use of Angiography for Pediatric Blunt Liver/Spleen Injuries Post 2019 APSA Guidelines.

PURPOSE: To evaluate the use of angiography in pediatric blunt abdominal trauma with hepatic and/or splenic injuries following the 2019 Updated APSA Blunt Liver/Spleen Injury Guidelines. METHODS: The Trauma Quality Improvement Program (2020-2023) was queried for patients ≤18-years-old who sustained blunt abdominal trauma resulting in hepatic and/or splenic injury. Patient demographics, injury characteristics, interventions, and outcomes were analyzed. Trauma centers were categorized as adult, dual adult-pediatric, or pediatric trauma centers. Multivariable logistic regression was used to identify predictors of angioembolization and splenectomy. Patients with concomitant penetrating trauma and patients who died in the emergency room were excluded. RESULTS: A total of 13,788 pediatric patients were identified. Most (13,363; 97%) were managed without interventional radiology procedures, while 217 (1.6%) underwent diagnostic angiography only and 208 (1.5%) underwent angioembolization. Patients undergoing angiography or angioembolization had greater injury severity compared with those managed without interventional radiology (median ISS 29 and 35 vs 17, p < 0.001). Markers of hemorrhage were more common among patients undergoing angioembolization, including transfusion requirement (85% vs 18%, p < 0.001). Notably, only 47% of patients undergoing angiography without embolization required transfusion. Angioembolization utilization differed by trauma center type (2.0% adult, 1.7% dual, 0.8% pediatric; p < 0.001). In addition, angioembolization was not independently associated with decreased odds of splenectomy. CONCLUSIONS: Despite the updated 2019 APSA guidelines, angiography and angioembolization utilization continue to vary across trauma center types. While interventional radiology remains more common in patients with markers of severe injury, a subset of patients underwent angiography without transfusion requirement, suggesting potential continued overutilization and opportunities to further standardize guideline-based care.