Infectious disease issues affecting trauma patients in the developing world and of completely unimmunized patients are discussed elsewhere. As of 2017, a 13-valent anti-streptococcal vaccination has become available in some markets. ![]() Anti-streptococcal vaccination is evolving, and polyvalent vaccines are becoming more used and, over time, have been developed against a wider spectrum of subspecies. Fortunately, as of the 2010s in the developed world, there are effective vaccines for the latter two, which are usually given to children prior to entering elementary school ( H. Historically, the most feared organisms in this setting have been Streptococcus, Neisseria meningitis, and Haemophilus influenzae type B. Antipneumococcal vaccination is typically given around 2 to 3 weeks after splenectomy to decrease the risk of catastrophic sepsis events. To reduce potential care delays, the emergency care provider is advised to clarify ahead of time if there are any age cutoffs for trauma patient management in general and spleen injury cases in particular at their specific facility. Pediatric spleen trauma management is similar to that in adults. The role of antihemorrhagic intravenous agents such as tranexamic acid is discussed elsewhere. These grades often guide treatment decisions, such as if observational or operative management is chosen for the spleen injury by the treating surgeon. ![]() Grade 5 is either a shattered spleen or complete devascularization of the entire spleen. Grade 4 is a laceration involving a hilar or segmental blood vessel if there is partial devascularization or if it is more than 25% of the spleen. ![]() Grade 3 is hematoma of more than 50% of the subcapsular surface area or if the hematoma is known to be expanding over time, if the hematoma has ruptured, intraparenchymal hematoma either more than 5 cm or known to be expanding, or capsule laceration more than 3 cm in depth and/or involving a trabecular blood vessel. Grade 2 is hematoma 10 to 50% of surface or capsule laceration 1 to 3 cm in depth. Grade 1 is less than 10% of surface area involved in hematoma or capsule laceration less than 1 cm. Spleen trauma is graded from 1 to 5 in increasing order of severity.
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