title: Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centers with Low Trauma Incidence and in the Presence of Established Risk Factors.
abstract: BACKGROUND
  Treatment of blunt splenic trauma has undergone dramatic changes over the last few decades. Nonoperative management (NOM) is now the preferred treatment of choice, when possible. The outcome of NOM has been evaluated. This study evaluates the results following the management of blunt splenic injury in adults in a Swedish university hospital with a low blunt abdominal trauma incidence.
  
  
  METHODS
  Fifty patients with blunt splenic trauma were treated at the Department of Surgery, Lund University Hospital from January 1994 to December 2003. One patient was excluded due to a diagnostic delay of > 24 h. Charts were reviewed retrospectively to examine demographics, injury severity score (ISS), splenic injury grade, diagnostics, treatment and outcome measures.
  
  
  RESULTS
  Thirty-nine patients (80%) were initially treated nonoperatively (NOM), and ten (20%) patients underwent immediate surgery (operative management, OM). Only one (3%) patient failed NOM and required surgery nine days after admission (failure of NOM, FNOM). The patients in the OM group had higher ISS (p < 0.001), higher grade of splenic injury (p < 0.001), and were hemodynamically unstable to a greater extent (p < 0.001). This was accompanied by increased transfusion requirements (p < 0.001), longer stay in the ICU unit (p < 0.001) and higher costs (p = 0.001). Twenty-seven patients were successfully treated without surgery. No serious complication was found on routine radiological follow-up.
  
  
  CONCLUSIONS
  Most patients in this study were managed conservatively with a low failure rate of NOM. NOM of blunt splenic trauma could thus be performed in a seemingly safe and effective manner, even in the presence of established risk factors. Routine follow-up with CT scan did not appear to add clinically relevant information affecting patient management.
authors.forename: Gustav
authors.initials: G
authors.lastname: Norrman
authors.forename: Bobby
authors.initials: B
authors.lastname: Tingstedt
authors.forename: Mikael
authors.initials: M
authors.lastname: Ekelund
authors.affiliation: Department of Surgery, Clinical Sciences Lund, Lund University Hospital, Lund, Sweden. roland.andersson@med.lu.se.|Department of Surgery, Clinical Sciences Lund, Lund University Hospital, 221 85, Lund, Sweden. roland.andersson@med.lu.se.
authors.forename: Roland
authors.initials: R
authors.lastname: Andersson
keywords: Blunt splenic trauma; Nonoperative management; Outcome; Risk factors
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