title: Protocol-driven nonoperative management in patients with blunt splenic trauma and minimal associated injury decreases length of stay.
abstract: BACKGROUND
  The purpose of this study was to analyze the impact of more selective use of admission angiography combined with protocolized nonoperative management for blunt splenic injury.
  
  
  METHODS
  This was a retrospective chart review of all patients with splenic injuries and Injury Severity Score < 20 managed by protocol and comparison with a prior matched group managed with admission angiography.
  
  
  RESULTS
  Forty-three patients were managed under the protocol, with 22 patients treated with admission angiography and the remainder undergoing observation only. Nonoperative salvage was 100% in this group, with a length of stay of 3.3 days. The matched, nonprotocol group had a nonoperative salvage rate of 95%, with a length of stay of 6.8 days.
  
  
  CONCLUSIONS
  Protocol-driven management of splenic injury using admission angiography selectively for higher grade splenic injuries led to a decreased length of stay, higher therapeutic yield, and decreased use of hospital resources without any increase in the failure rate of nonoperative management in a selected group of patients with isolated splenic injuries.
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201-1595, USA. jhaan@trauma.ummc.umaryland.edu
authors.forename: James
authors.initials: J
authors.lastname: Haan
authors.forename: Obeid N
authors.initials: ON
authors.lastname: Ilahi
authors.forename: Mary
authors.initials: M
authors.lastname: Kramer
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: John
authors.initials: J
authors.lastname: Myers
mesh_terms: D000328:Adult; D000792:Angiography; D002985:Clinical Protocols; D003955:Diagnostic Tests, Routine; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy*