Observation for nonoperative management of the spleen: how long is long enough?
BACKGROUND
Nonoperative management of splenic injury is common with reported success rates between 83% and 97%. However, there are no specific protocols for nonoperative observation published in the literature. The purpose of this study is to analyze the safety and effectiveness of our institutional guideline for observation of patients managed nonoperatively for splenic injury.


METHODS
A retrospective registry and chart review was conducted for all patients with splenic injury who were admitted for nonoperative management (NOM). Our guideline for observation is admission with bed rest, serial hemoglobins every 6 hour, and discharge when hemoglobin is stable. Data collected for this study was age, gender, Injury Severity Score, grade of splenic injury, length of stay, NOM failures while in hospital and readmissions after discharge for nonoperative failure.


RESULTS
From August 2002 through June 2007, 449 patients were admitted for NOM of splenic injury. Sixteen (4%) patients failed NOM and went to the operating room for splenectomy.


CONCLUSIONS
NOM of blunt splenic injuries had a 96% success rate following our protocol. The guideline successfully identified all the patients failing NOM during the inpatient observation period with the exception of one patient that was noncompliant to protocol. This guideline for observation is safe and effective.
McCray
Victor W
VW
Department of Surgery, UCSF-Fresno, Community Regional Medical Center, Fresno, California 93721, USA. vmccray@fresno.ucsf.edu
Davis
James W
JW
Lemaster
Deborah
D
Parks
Steven N
SN
D000007:Abdominal Injuries / Q000175:diagnosis / Q000628:therapy*; D000328:Adult; D001510:Bed Rest; D004621:Embolization, Therapeutic; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D019370:Observation; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy; D016896:Treatment Outcome