title: Management of spleen injuries: the current profile.
abstract: BACKGROUND
  There has been a shift from operative to conservative management of splenic injuries in the last two decades, but the current practice in Australia is not known. This study aims to determine the profile of splenic injury in major trauma victims and the approach to treatment in Victoria for the last 2 years.
  
  
  METHODS
  A review of prospectively collected data from the Victorian State Trauma Registry (VSTR) from July 2005 to June 2007 was conducted. Demographic data, details of the event, clinical observations, management and associated outcomes were extracted from the database. The patients were categorized into four groups according to management (conservative, splenectomy, embolization and repair) and were compared accordingly. Multivariate binary logistic regression was performed to identify predictors of treatment (conservative versus splenectomy) on arrival.
  
  
  RESULTS
  Of the 318 major trauma patients with splenic injuries, 186 (59%) were treated conservatively, 103 (32%) with splenectomy, 17 (5%) with arterial embolization and 12 (4%) with repair. Of these, 14 (14%) splenectomy cases and 2 (12%) embolization cases did not receive their respective treatments within 24 h. The severity of the spleen injury (as measured by the Abbreviated Injury Scale (AIS)) and age were identified as significant independent predictors of the form of treatment provided.
  
  
  CONCLUSIONS
  In Victoria, conservative management is the preferred approach in patients with minor (AIS = 2) to moderate (AIS = 3) splenic injuries. The low rates of embolization warrant further research into whether splenectomy is overused.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Antonina
authors.initials: A
authors.lastname: Mikocka-Walus
authors.forename: Harriet C
authors.initials: HC
authors.lastname: Beevor
authors.forename: Belinda
authors.initials: B
authors.lastname: Gabbe
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
authors.forename: Jason
authors.initials: J
authors.lastname: Winnett
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
mesh_terms: D000007:Abdominal Injuries / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012042:Registries; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy; D014739:Victoria; D055815:Young Adult