The evolution of blunt splenic injury: resolution and progression.
BACKGROUND
Nonoperative management of blunt splenic injury (BSI) has become the standard of care for hemodynamically stable patients. Successful nonoperative management raises two related questions: (1) what is the time course for splenic healing and (2) when may patients safely return to usual activities? There is little evidence to guide surgeon recommendations regarding return to full activities. Our hypothesis was that time to healing is related to severity of BSI.


METHODS
The trauma registry at a level I trauma center was queried for patients diagnosed with a BSI managed nonoperatively between 2002 and 2007. Follow-up abdominal computed tomography scans were reviewed with attention to progression to healing of BSI. Kaplan-Meier curves were compared for mild (American Association for the Surgery of Trauma grades I-II) and severe (grades III-V) BSI.


RESULTS
Six hundred thirty-seven patients (63.9% mild spleen injury and 36.1% severe injury) with a BSI were eligible for analysis. Fifty-one patients had documented healing as inpatients. Ninety-seven patients discharged with BSI had outpatient computed tomography scans. Nine had worsening of BSI as outpatients and two (1 mild and 1 severe) required intervention (2 splenectomies). Thirty-three outpatients were followed to complete healing. Mild injuries had faster mean time to healing compared with severe (12.5 vs. 37.2 days, p < 0.001). Most healing occurred within 2 months but approximately 20% of each group had not healed after 3 months.


CONCLUSIONS
Although mild BSIs heal faster than severe BSIs, nearly 10% of all the BSIs followed as outpatients worsened. Close observation of patients with BSI should continue until healing can be confirmed.
Savage
Stephanie A
SA
Department of General Surgery, Wilford Hall Medical Center, Lackland AFB, Texas, USA. stephanie.savage@lackland.af.mil
Zarzaur
Ben L
BL
Magnotti
Louis J
LJ
Weinberg
Jordan A
JA
Maish
George O
GO
Bee
Tiffany K
TK
Minard
Gayle
G
Schroeppel
Thomas
T
Croce
Martin A
MA
Fabian
Timothy C
TC
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013154:Spleen / Q000293:injuries*; D013161:Splenic Rupture / Q000000981:diagnostic imaging* / Q000628:therapy*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*