521 Cases of blunt hepatic & splenic injury - multidisciplinary, non-operative management (NOM) in a large Western-Europe Trauma centre

Abstract

Background: Despite widespread use of NOM for blunt injury to liver and spleen, data from European centres are scarce. We aimed to investigate the outcome of these patients at a large trauma referral centre in Austria and develop a clinical algorithm to detect the risk factors for failure of non-operative management. Methods: Retrospective review based on all emergency patients with admission to Medical University Innsbruck 2006-2016. Injury severity details, clinical, operative and non-operative treatment parameters, morbidity and mortality were evaluated. On these factors a systematic, therapeutic algorithm was created. Results: 521 patients were treated with splenic and/or hepatic injury, 227 had splenic injury, 238 hepatic injury and 56 cases splenic + hepatic trauma. 84.1% underwent initial NOM, of which 2.1% received embolization and/or ERCP. All other NOM cases were managed with bed-rest. The secondary failure rate of NOM was 3.2%. Reasons for failure were: persisting haemorrhage (72%), haematoma (14%) and infections (14%). The rate of patients per year with NOM did not significantly change during the study-period. In-hospital mortality rate was 1.7%. Risk factors for failure of NOM will be presented, as well as a proposed algorithm for management of traumatic liver and spleen injury. Conclusion: NOM is the standard of care for blunt hepatic and splenic injury and successful in >80% of patients. The presented clinical algorithm is primarily guided by clinical parameters and is safe with a low mortality rate <2%.