title: Is non-operative management safe and effective for all splenic blunt trauma? A systematic review.
abstract: BACKGROUND
  The goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay.
  
  
  METHODS
  For this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST.
  
  
  RESULTS
  We identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison.
  
  
  CONCLUSIONS
  NOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.forename: Alessia
authors.initials: A
authors.lastname: Corsi
authors.forename: Eriberto
authors.initials: E
authors.lastname: Farinella
authors.forename: Chiara
authors.initials: C
authors.lastname: Listorti
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Claudio
authors.initials: C
authors.lastname: Renzi
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Alberto
authors.initials: A
authors.lastname: Santoro
authors.forename: Lucio
authors.initials: L
authors.lastname: Cagini
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
authors.forename: Adriano
authors.initials: A
authors.lastname: Redler
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000628:therapy; D002986:Clinical Trials as Topic / Q000379:methods; D019468:Disease Management; D006801:Humans; D061214:Patient Safety; D013154:Spleen / Q000293:injuries*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*