Blunt splenic trauma: predictors for successful non-operative management.
BACKGROUND
Non-operative management of blunt splenic trauma is the preferred option in hemodynamically stable patients.


OBJECTIVE
To identify predictors for the successful non-operative management of patients with blunt splenic trauma.


METHODS
The study group comprised consecutive patients admitted with the diagnosis of blunt splenic trauma to the Department of Surgery, Hadassah-Hebrew University Medical Center in Jerusalem over a 3 year period. Prospectively recorded were hemodynamic status, computed tomography grade of splenic tear, presence and extent of extra-abdominal injury, number of red blood cell units transfused, and outcome. Hemodynamic instability and the severity of associated injuries were used to determine the need for splenectomy. Hemodynamically stable patients without an indication for laparotomy were admitted to the Intensive Care Unit and monitored.


RESULTS
There were 64 adults (45 males, mean age 30.2 years) who met the inclusion criteria. On univariate analysis the 13 patients (20.3%) who underwent immediate splenectomy were more likely to have lower admission systolic blood pressure (P= 0.001), Glasgow Coma Scale < 8 (P= 0.02), and injury to at least three extra-abdominal regions (P= 0.06). Nine of the 52 patients (17.3%) who were successfully treated non-operatively suffered from grade > or = 4 splenic tear. Multivariate analysis identified admission systolic BP (odds ratio 1.04) and associated injury to less than three extra-abdominal regions (OD 8.03) as predictors for the success of non-operative management, while the need for blood transfusion was a strong predictor (OR 66.67) for splenectomy.


CONCLUSIONS
Admission systolic blood pressure and limited extra-abdominal injury can be used to identify patients with blunt splenic trauma who do not require splenectomy and can be safely monitored outside an ICU environment.
Bala
Miklosh
M
Department of General Surgery, Hadassah-Hebrew University Medical Center, lerusalem, Israel. mikloshbala@gmail.com
Edden
Yair
Y
Mintz
Yoav
Y
Kisselgoff
David
D
Gercenstein
Irina
I
Rivkind
Avraham I
AI
Farugy
Muhammad
M
Almogy
Gidon
G
D000007:Abdominal Injuries / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013154:Spleen / Q000293:injuries*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*