title: Splenic injuries: factors affecting the outcome of non-operative management.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcome of non-operative management (NOM) in patients with splenic injuries and to determine the predictive factors of NOM failure.
  
  
  METHODS
  Two hundred and six patients with splenic injury were admitted between January 2005 and April 2011. Of the 206 patients with splenic injury, 47 patients met the inclusion criteria of NOM. The mechanism of injury, grade of splenic injury, other intra- and extra-abdominal injuries, systolic blood pressure on admission, hemoglobin levels, number of transfusions, Injury Severity Score (ISS), Glasgow Coma Scale score, and hospitalization period were recorded. The patients were divided into two groups: those with NOM and those in whom the failure of NOM led to laparotomy. The patients were monitored for vital signs, abdominal findings, and laboratory data. NOM was abandoned in cases of hemodynamic instability, ongoing bleeding, or development of peritonitis. Independent predictive factors of NOM failure were identified. The patients managed non-operatively were compared with the patients for whom NOM failed.
  
  
  RESULTS
  NOM was successful in 40 of 47 patients. There were differences between the two groups for ISS, hemoglobin levels, need for blood transfusion, and the number of associated extra-abdominal injuries. The grade of splenic injury was determined to be an important and significant independent predictive factor for the success of NOM of splenic injuries.
  
  
  CONCLUSIONS
  The grade of splenic injury is an important and significant independent predictor factor for the success of NOM. NOM is not recommended in patients with high-grade splenic injury.
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey. azboyuk@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Böyük
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Gümüş
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Önder
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Kapan
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Aliosmanoğlu
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Taşkesen
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Arıkanoğlu
authors.affiliation: Department of General Surgery, Medical Faculty, Dicle University, Yenişehir, 21280, Diyarbakır, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Gedik
keywords: Non-operative management; Predictive factor; Splenic injury
references.citation: J Am Coll Surg. 2004 Feb;198(2):232-9
references.pmid: 14759780
references.citation: Am Surg. 2001 Aug;67(8):793-6
references.pmid: 11510586
references.citation: Lymphology. 1999 Jun;32(2):64-9
references.pmid: 10389113
references.citation: J Trauma. 2003 May;54(5):925-9
references.pmid: 12777905
references.citation: J Trauma. 1999 Jan;46(1):87-90
references.pmid: 9932688
references.citation: J Trauma. 2000 May;48(5):801-5; discussion 805-6
references.pmid: 10823522
references.citation: J Trauma. 2001 Feb;50(2):230-6
references.pmid: 11242286
references.citation: Isr Med Assoc J. 2007 Dec;9(12):857-61
references.pmid: 18210925
references.citation: J Trauma. 1995 Mar;38(3):323-4
references.pmid: 7897707
references.citation: Am J Surg. 2005 Aug;190(2):273-8
references.pmid: 16023445
references.citation: Eur J Trauma Emerg Surg. 2009 Apr;35(2):90-4
references.pmid: 26814759
references.citation: J Intensive Care Med. 2006 Sep-Oct;21(5):296-304
references.pmid: 16946445
references.citation: Curr Opin Crit Care. 2007 Aug;13(4):399-404
references.pmid: 17599009
references.citation: Am Surg. 2005 May;71(5):379-86
references.pmid: 15986966
references.citation: Arch Surg. 2003 Aug;138(8):844-51
references.pmid: 12912742
references.citation: Ann Surg. 1998 May;227(5):708-17; discussion 717-9
references.pmid: 9605662
references.citation: World J Surg. 2001 Nov;25(11):1393-6
references.pmid: 11760740
references.citation: Surgery. 2009 Oct;146(4):787-91; discussion 791-3
references.pmid: 19789039
references.citation: Am Surg. 2000 Jul;66(7):631-5
references.pmid: 10917472
references.citation: J Trauma. 2008 Apr;64(4):943-8
references.pmid: 18404060
references.citation: World J Surg. 2001 Nov;25(11):1403-4
references.pmid: 11760742
references.citation: Ann Surg. 2006 Oct;244(4):620-8
references.pmid: 16998371
references.citation: Emerg Med J. 2008 Apr;25(4):210-2
references.pmid: 18356350
references.citation: Arch Surg. 2000 Jun;135(6):674-9; discussion 679-81
references.pmid: 10843363
references.citation: Arch Surg. 2005 Jun;140(6):563-8; discussion 568-9
references.pmid: 15967903
references.citation: J Trauma. 2008 Dec;65(6):1354-8
references.pmid: 19077626
references.citation: Clin Radiol. 2005 Sep;60(9):968-76
references.pmid: 16124978