Feasibility of nonoperative management of grade III and IV splenic injury in hemodynamically stable patients in limited ICU settings: A prospective study

Abstract

Background: The management of splenic injuries has evolved over the years. The objective of this study was to evaluate the feasibility of nonoperative management (NOM) of higher grades (grade III and IV) of splenic trauma in limited intensive care unit (ICU) settings. Patients and Methods: This prospective study was carried out in the Department of Surgery Government Medical College, Srinagar over a period of 1.5 year from January 2012 to June 2013. The study included 50 hemodynamically stable patients with computed tomography (CT) documented grade III or IV splenic trauma (30 patients with grade III and 20 patients with grade IV). Vigorous monitoring was done in general surgical ward setup during first 2-3 days of trauma consisting of hourly monitoring by the resident doctor on the 1 st day and 3-hourly monitoring thereafter. Results: Most common mode of trauma was road traffic accident (20, 40%) followed by fall from height (15, 30%), human violence (10, 20%), and others including animal assault (5, 10%). Ninety-four percent of our patients were managed nonoperatively without any mortality. Fourteen patients from group A (grade III) and 17 patientsfrom group B (grade IV) required blood transfusions. Ninety-three percent of the patients from group A and 45% of patients from group B were managed in the ward setting without any need for ICU setup. Children with grade III laceration showed complete resolution on CT after an average of 5.2 months and those with grade IV laceration on CT after an average of 9.3 months. Conclusion: NOM of higher grades of splenic trauma appears to be feasible in centers with limited ICU facilities, though it demands strict and continuous monitoring during initial 2-3 days.