Nonoperative management of splenic injury in combat: 2002-2012.
BACKGROUND
Selective nonoperative management of combat-related blunt splenic injury (BSI) is controversial. We evaluated the impact of the November 2008 blunt abdominal trauma clinical practice guideline that permitted selective nonoperative management of some patients with radiological suggestion of hemoperitoneum on implementation of nonoperative management (NOM) of splenic injury in austere environments.


METHODS
Retrospective evaluation of patients with splenic injuries from November 2002 through January 2012 in Iraq and Afghanistan was performed. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes identified patients as laparotomy with splenectomy, or NOM. Delayed operative management had no operative intervention at earlier North American Treaty Organization (NATO) medical treatment facilities (MTFs), and had a definitive intervention at a latter NATO MTFs. Intra-abdominal complications and overall mortality were juxtaposed.


RESULTS
A total of 433 patients had splenic injuries from 2002 to 2012. Initial NOM of BSI from 2002 to 2008 compared to 2009-2012 was 44.1% and 47.2%, respectively (p=0.75). Delayed operative management and NOM completion had intra-abdominal complication and mortality rates of 38.1% and 9.1% (p<0.01), and 6.3% and 8.1% (p=0.77).


CONCLUSIONS
Despite high-energy explosive injuries, NATO Role II MTFs radiological constraints and limited medical resources, hemodynamically normal patients with BSI and low abdominal abbreviated injury scores underwent NOM in austere environments.
U.S. Military General Surgery, San Antonio Military Medical Center, 3851 Roger Brooke Drive #3600, San Antonio, TX 78234-7767.
Thomas A
TA
Mitchell
U.S. Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767.
Timothy E
TE
Wallum
U.S. Military General Surgery, San Antonio Military Medical Center, 3851 Roger Brooke Drive #3600, San Antonio, TX 78234-7767.
Tyson E
TE
Becker
U.S. Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767.
James K
JK
Aden
U.S. Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767.
Jeffrey A
JA
Bailey
U.S. Military General Surgery, San Antonio Military Medical Center, 3851 Roger Brooke Drive #3600, San Antonio, TX 78234-7767.
Lorne H
LH
Blackbourne
U.S. Military General Surgery, San Antonio Military Medical Center, 3851 Roger Brooke Drive #3600, San Antonio, TX 78234-7767.
Christopher E
CE
White
D000007:Abdominal Injuries / Q000175:diagnosis / Q000628:therapy*; D000328:Adult; D055826:Afghan Campaign 2001-; D019468:Disease Management; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014481:United States; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*