Management of Splenic Injuries Utilizing a Multidisciplinary Protocol in 110 Consecutive Patients at a Level II Hospital

Abstract

IntroductionNon-operative treatment (NOM) of splenic trauma is the management of choice in hemodynamically stable patients. Aim of the present study was to assess the failure rate of the NOM after implantation of a multidisciplinary protocol for splenic injuries comparing the results with the literature. Methods16-year retrospective study. Management of these lesions was recorded according to our hospital protocol: demographic data, blood pressure, respiratory rate, Glasgow Coma Scale(GCS), Revised Trauma Score(RTS), Injury Severity Score(ISS), grades of injuries according to the American Association for the Surgery of Trauma(AAST), failure of the NOM, morbidity and mortality. Results110 patients were included, 90 (81.8%) men, 20 (18.2%) women; mean age 37 years; 106 (96.5%) cases were blunt and four (3.5%) penetrating by knife. The diagnosis was established by US/CT. AAST classification: 14 (13%) patients were grade I; 24 (22%) grade II; 34 (31%) grade III; 37 (34%) grade IV. Emergency laparotomy was performed in 54 patients: 37 due to grade IV injuries, 17 due to hemodynamic instability. NOM was established in 56, conservative surgery in 16 and splenectomy in 38. Ten patients presented postoperative complications: seven in the splenectomy group, two in the conservative surgery group and one in non-operative group. One patient died. Average hospital stay: 22.8 days- TNO 17.6 days, conservative surgery 29, splenectomy 22.4 days. ConclusionsAlthough we continue with a high hospital stay, our results are comparable to the literature. The implementation of the protocol by consensus contributed to the change towards NOM.