Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study.

Abstract

To review the management of patients >16years with blunt splenic injury in a single, UK, major trauma centre and identify whether the following are associated with success or failure of non-operative management with selective use of arterial embolization (NOM±AE): age, Injury Severity Score (ISS), head injury, haemodynamic instability, massive transfusion, radiological hard signs [contrast extravasation or pseudoaneurysm on the initial computed tomography (CT) scan], grade, and presence of intraparenchymal haematoma or splenic laceration. Retrospective, cross-sectional study undertaken between April 2012 and October 2015. Paediatric patients, penetrating splenic trauma, and iatrogenic injuries were excluded. Follow-up was for at least 30days. 154 patients were included. Median age was 38years, 77.3% were male, and median ISS was 22. 14/87 (16.1%) patients re-bled following NOM in a median of 2.3days (IQR 0.8-3.6days). 8/28 (28.6%) patients re-bled following AE in a median of 2.0days (IQR 1.3-3.7days). Grade III-V injuries are a significant predictor of the failure of NOM±AE (OR 15.6, 95% CI 3.1-78.9, p=0.001). No grade I injuries and only 3.3% grade II injuries re-bled following NOM±AE. Age ≥55years, ISS, radiological hard signs, and haemodynamic instability are not significant predictors of the failure of NOM±AE, but an intraparenchymal or subcapsular haematoma increases the likelihood of failure 11-fold (OR 10.9, 95% CI 2.2-55.1, p=0.004). Higher grade injuries (III-V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM±AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24h with appropriate advice.