The role of diagnostic algorithms in the management of blunt splenic injury.
BACKGROUND
Diagnostic algorithms for patients with blunt abdominal trauma have been in use since 1995. This study investigated the role of diagnostic algorithms in the management of adult patients with blunt splenic injury at our institution.


METHODS
A retrospective review of hospital records was performed to enroll patients with blunt injury of the spleen. Demographic data and information about injury severity, diagnostic methods, management and final outcomes were evaluated. Patients were separated into an early and late group according to the year that diagnostic algorithms were used (1990-1994 or 1995-1999).


RESULTS
One hundred and twenty-one patients were enrolled. Initially, 71 patients had an operation (OP group), whereas 50 received non-operative management (NOM group). Patients in the OP versus NOM group had lower blood pressure and greater transfusion volumes in the emergency room, higher grade splenic injury, and a greater rate of intra-abdominal-related injury. NOM failed in 7 patients (14%). Early- versus late-group patients were less likely to have NOM and high grade splenic injury; however, the rate of NOM failure was not different between the early and late groups.


CONCLUSIONS
Diagnostic algorithms using sonograms for screening provide an initial means of selecting patients for NOM. Patients with higher grades of splenic injury can then be managed non-operatively.
Chen
Liang-Yu
LY
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Shih
Hsin-Chin
HC
Wu
Jackson Jer-kan
JJ
Wen
Yi-Szu
YS
Huang
Mu-Shun
MS
Huang
Chun-I
CI
Lee
Chen-Hsen
CH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy*