Management of blunt hepatic and splenic trauma in a Greek level I trauma centre.
OBJECTIVE
Non-operative management (NOM) has revolutionized the care of blunt hepatic and splenic trauma patients. The objective of this study is to evaluate treatment of such patients in a Greek level I trauma centre, to identify factors that are important for selecting them for NOM and to investigate for predictors of NOM failure.


METHODS
We reviewed the Trauma Registry data of 96 consecutive adult patients admitted with blunt liver and/or splenic injuries over a 4-year period.


RESULTS
Immediately operated patients (32.3%) had lower diastolic arterial pressure (p = 0.02), lower International Classification of Diseases -9th revision Injury Severity Score (ICISS) (p = 0.01), and a higher grade of splenic injury (p = 0.002) than NOM patients. NOM success rate was 80%. No predictors of NOM failure were found ; however, isolated splenic trauma patients failed NOM more frequently than hepatic patients (p = 0.02).


CONCLUSIONS
NOM of adult blunt hepatic and splenic trauma patients is safe and efficient. Haemodynamic stability, ICISS and the grade of splenic injury are important for selecting these patients for NOM while splenic trauma patients need more intense observation.
Markogiannakis
H
H
Department of Surgical Oncology, Herakleion University Hospital, Herakleion Medical School, University of Crete, Herakleion, Crete, Greece. markogiannakis@easy.com
Sanidas
E
E
Messaris
E
E
Michalakis
I
I
Kasotakis
G
G
Melissas
J
J
Tsiftsis
D
D
D000007:Abdominal Injuries / Q000628:therapy; D000328:Adult; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries*; D008297:Male; D013154:Spleen / Q000293:injuries*; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000628:therapy*