title: Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy.
abstract: BACKGROUND
  There is growing evidence of clinical data recently for successful outcomes of non-operative management (NOM) for blunt hepatic and spleen injuries (BHSI). However, the effectiveness of NOM for high-grade BHSI remains undefined. The aim of the present study was to review our experience with NOM in high-grade BHSI and compare results with the existing related data worldwide.
  
  
  METHODS
  In this retrospectively protocol-driven study, 150 patients with grade 3-5 BHSI were enrolled during a 3-year period. Patients were divided into immediate laparotomy (immediate OP) and initial non-operative (initial NOM) groups according to hemodynamic status judged by duty trauma surgeon. Patients who received initial NOM were divided into successful NOM (s-NOM) and failed NOM (f-NOM) subgroups according to conservative treatment failure. We analyzed the clinical characteristics and the outcomes of patients.
  
  
  RESULTS
  Twenty-eight (18.7%) patients underwent immediate operations, and the remaining 122 (81.3%) were initially treated with NOM. Compared with the initial NOM group, the immediate OP group had significantly lower hemoglobin levels, a higher incidence of tube thoracostomy, contrast extravasation and large hemoperitoneum on computed tomography, a higher injury severity score, increased need for transfusions, and longer length of stay (LOS) in the intensive care unit (ICU) and hospitalization. Further analysis of the initial NOM group indicated that NOM had failed in 6 (4.9%) cases. Compared with the s-NOM subgroup, f-NOM patients had significantly lower hemoglobin levels, more hospitalized transfusions, and longer ICU LOS.
  
  
  CONCLUSIONS
  NOM of high-grade BHSI in selected patients is a feasible strategy. Notwithstanding, patients with initial low hemoglobin level and a high number of blood transfusions in the ICU are associated with a high risk for NOM failure.
authors.affiliation: Division of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
authors.forename: Ting-Min
authors.initials: TM
authors.lastname: Hsieh
authors.affiliation: Department of Emergency, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
authors.forename: Tsung
authors.initials: T
authors.lastname: Cheng Tsai
authors.affiliation: Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
authors.forename: Jiun-Lung
authors.initials: JL
authors.lastname: Liang
authors.affiliation: Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
authors.forename: Chih
authors.initials: C
authors.lastname: Che Lin
keywords: Blunt hepatic and splenic injuries; Blunt hepatic injury; Blunt splenic injury; Non-operative management