Blunt Splenic Trauma

Abstract

Since January 2004, 105 patients (2.5% of total trauma admissions) were seen having suffered splenic injury; of these, 85 (81%) suffered blunt injury. Mortality was 19% patients (20 of 105). The overall median Injury Severity Score (ISS) was 35. Fifty-fivepatients had alaparotomy (52%). The total number of splenectomies performed was 34 (a rate of 32%) and the median ISS in this group was 40. Of the patients who survived, 24 had a splenectomy and 16 had alaparotomy and splenic preservation surgery (packing, spleen seen to have stopped bleedingand requiring no intervention). Ten of the patients who died had a splenectomy and 5 had a laparotomy and the spleen was preserved. The median ISS in the group treated conservatively was 27. Only 4 patients had an isolated splenic injury. Five patients underwent splenic artery emobolisation with good effect. The high ISS in those undergoing splenectomy re-emphasises the surgical dilemma of whether or not to attempt preservation of the damaged spleen in light of injuries to other body regions. The paper highlights the problem with splenic injury grading from CT scanning and we feel that further efforts should be made to encourage radiologists to report CT scans by grade to help in measuring the Abbreviated Injury Score(AIS) and ISS and subsequently to improve management decisions. We routinely perform Focused Assessment by Sonography in Trauma (FAST) as part of our initial investigations. Cardiovascularly unstable patients with apositive FAST scan are protocolised to the operating theatre immediately. We have found no benefit from radiological follow-up of splenic injury, ultrasound or otherwise. Splenic trauma is found in aminority of injured patients and our experience suggests that a high-volume centre can organise care by concentrating through-put. Whilst it is imperative that all surgeons are familiar with the indications and strategies for surgical versus conservative therapy, the management of such patients is best conducted in high-volume centres by dedicated trauma specialists and support services. Such centres provide surgical and decision-making experience for the surgical trainee.