title: Management of blunt splenic injuries Retrospective cohort study of early experiences in an Acute Care Surgery Service recently established.
abstract: OBJECTIVE
  To identify patients with splenic injuries, who should benefit from a conservative treatment, and to compare inhospital follow-up and hospital length of stay (LOS), in patients treated by non-operative management (NOM) versus immediate-splenectomy (IS).
  
  
  METHODS
  A retrospective cohort study on consecutive patients, with all grade of splenic injuries, admitted between November 2010 and December 2014 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara. Patients were offered NOM or IS.
  
  
  RESULTS
  Fifty-four patients were enrolled; 29 (53.7%) underwent IS and 25 (46.3%) were offered NOM. Splenic artery angioembolization was performed in 9 patients (36%) among this latter group. High-grade splenic injuries (IVV) were more represented in IS group (65.5% vs 8%), while low grade (I-II) were more represented in NOM group (64% vs 10.3%). Failure of NOM occurred in 4 patients (16%). Hospital LOS was longer in IS group (p=0.044), while in-hospital and 30-day mortality were not statistically significant different between the two groups.
  
  
  CONCLUSIONS
  Hemodynamically stable patients, with grade I to III of splenic injuries, without other severe abdominal organ injuries, could benefit from a NOM; the in-hospital follow-up should be done, after a control CECT scan, with US. Observation and strictly monitoring of splenic injuries treated with NOM do not affect patients' hospital los.
  
  
  BACKGROUND
  Non-operative management, Splenic Rupture, Surgery.
authors.forename: Savino
authors.initials: S
authors.lastname: Occhionorelli
authors.forename: Lucia
authors.initials: L
authors.lastname: Morganti
authors.forename: Dario
authors.initials: D
authors.lastname: Andreotti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cappellari
authors.forename: Rocco
authors.initials: R
authors.lastname: Stano
authors.forename: Mattia
authors.initials: M
authors.lastname: Portinari
authors.forename: Giorgio
authors.initials: G
authors.lastname: Vasquez
mesh_terms: D000328:Adult; D000368:Aged; D000072700:Conservative Treatment / Q000706:statistics & numerical data; D019468:Disease Management; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology / Q000628:therapy; D006489:Hemostatic Techniques; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000706:statistics & numerical data; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000628:therapy*