Blunt splenic injury in adults: a decision analysis comparing options for treatment.
OBJECTIVE
To evaluate factors which influence surgeons in their decision to treat blunt splenic injuries in adults by observation, splenorrhaphy or splenectomy.


METHODS
Decision analysis.


METHODS
Army hospital, USA.


METHODS
56 Selected papers on the treatment of splenic trauma published between 1983 and 1993.


METHODS
Variables evaluated included the incidence of transfusion, postsplenectomy sepsis, posttransfusion hepatitis, chronic active hepatitis, cirrhosis, and rebleeding.


METHODS
Quality adjusted life expectancies (QALE) after each procedure.


RESULTS
QALEs when the mean incidence of each variable was used in the decision analysis were 39.68 years for observation, 39.56 years for splenorrhaphy, and 38.94 years for splenectomy. Sensitivity analysis showed that when the incidence of transfusion was controlled, splenorrhaphy was superior, and both splenorrhaphy and observation were superior to splenectomy. Once a patient had been given blood products the advantages of non-operative management were lost.


CONCLUSIONS
Only patients with minor splenic injuries who did not require blood transfusion should be treated by observation. Patients who require blood transfusion should be explored with the object of salvaging the spleen. Some patients with severe, devitalising injuries will require splenectomy despite the best attempts to salvage the organ.
D000328:Adult; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006505:Hepatitis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000628:therapy*