title: Nonoperative management of splenic injuries: significance of age.
abstract: BACKGROUND
  In the nonoperative management (NOM) of blunt splenic injuries (BSI), the clinical relevance of age as a risk factor has not been well studied.
  
  
  METHODS
  Using the 2011 National Trauma Data Bank data set, age was analyzed both as a continuous variable and a categorical variable (group 1 [13-54 y], group 2 [55-74 y], and group 3 [≥75 y]). BSI severity was stratified by abbreviated injury scale (AIS): group 1 (AIS ≤2), group 2 (AIS 3), and group 3 (AIS ≥4). A semiparametric proportional odds model was used to model NOM outcomes and effects due to age and BSI severity.
  
  
  RESULTS
  Of 15,113 subjects, 15.3% failed NOM. The odds of failure increased by a factor of 1.014 for each year of age, or factor of 1.5 for groups 2 and 3 each. BSI severity groups 2 and 3 had increases in the odds of failure by factors of 3.9 and 13, respectively, compared with those of group 1. Most failures occurred by 48 h irrespective of age. The effect of age was most pronounced in age groups 2 and 3 with the most severe BSI, where a NOM failure rate of >50% was seen. Both age and failure of NOM were independent predictors of mortality.
  
  
  CONCLUSIONS
  Age is associated with failure of NOM but its effect seems more clinically relevant only in high-grade BSI. Factors that could influence NOM success in elderly patients with high-grade injuries deserve further study.
authors: Department of Surgery, Section of Trauma, Reading Hospital and the University of Pennsylvania Perelman School of Medicine, Reading, Pennsylvania. Electronic address: adrian.ong@readinghealth.org.
authors: Adrian W
authors: AW
authors: Ong
authors: Department of Statistics, Eberly College of Science, Pennsylvania State University, Reading, Pennsylvania.
authors: Kirsten E
authors: KE
authors: Eilertson
authors: Department of Surgery, Section of Trauma, Reading Hospital and the University of Pennsylvania Perelman School of Medicine, Reading, Pennsylvania.
authors: Eugene F
authors: EF
authors: Reilly
authors: Department of Surgery, Section of Trauma, Reading Hospital and the University of Pennsylvania Perelman School of Medicine, Reading, Pennsylvania.
authors: Thomas A
authors: TA
authors: Geng
authors: Department of Surgery, Section of Trauma, Reading Hospital and the University of Pennsylvania Perelman School of Medicine, Reading, Pennsylvania.
authors: Firas
authors: F
authors: Madbak
authors: Section of Trauma, Department of Surgery, Reading Hospital, State College, Pennsylvania.
authors: Amanda
authors: A
authors: McNicholas
authors: Department of Surgery, Section of Trauma, Reading Hospital and the University of Pennsylvania Perelman School of Medicine, Reading, Pennsylvania.
authors: Forrest B
authors: FB
authors: Fernandez
mesh_terms: D000007:Abdominal Injuries / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D017211:Treatment Failure; D055815:Young Adult
keywords: Geriatric; Injuries; Nonoperative management; Spleen