Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).
OBJECTIVE
To determine the rate and predictors of failure of nonoperative management (NOM) in grade IV and V blunt splenic injuries (BSI).


METHODS
Retrospective case series.


METHODS
Fourteen trauma centers in New England.


METHODS
A total of 388 adult patients with a grade IV or V BSI who were admitted between January 1, 2001, and August 31, 2008.


METHODS
Failure of NOM (f-NOM).


RESULTS
A total of 164 patients (42%) were operated on immediately. Of the remaining 224 who were offered a trial of NOM, the treatment failed in 85 patients (38%). At the end, 64% of patients required surgery. Multivariate analysis identified 2 independent predictors of f-NOM: grade V BSI and the presence of a brain injury. The likelihood of f-NOM was 32% if no predictor was present, 56% if 1 was present, and 100% if both were present. The mortality of patients for whom NOM failed was almost 7-fold higher than those with successful NOM (4.7% vs 0.7%; P = .07).


CONCLUSIONS
Nearly two-thirds of patients with grade IV or V BSI require surgery. A grade V BSI and brain injury predict failure of NOM. This data must be taken into account when generalizations are made about the overall high success rates of NOM, which do not represent severe BSI.
Velmahos
George C
GC
Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02030, USA. gvelmahos@partners.org
Zacharias
Nikos
N
Emhoff
Timothy A
TA
Feeney
James M
JM
Hurst
James M
JM
Crookes
Bruce A
BA
Harrington
David T
DT
Gregg
Shea C
SC
Brotman
Sheldon
S
Burke
Peter A
PA
Davis
Kimberly A
KA
Gupta
Rajan
R
Winchell
Robert J
RJ
Desjardins
Steven
S
Alouidor
Reginald
R
Gross
Ronald I
RI
Rosenblatt
Michael S
MS
Schulz
John T
JT
Chang
Yuchiao
Y
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy; D014193:Trauma Centers; D015599:Trauma Severity Indices; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D055815:Young Adult