Outcomes in splenic injury at a high volume tertiary care centre

Abstract

Background: The objective of the present study was to study the outcomes of patients following splenic injury at a tertiary care centre.Methods: This prospective study was conducted over a period of 2 years, from January 2017 to December 2018, at Dayanand Medical College and Hospital, Ludhiana to include all patients presenting to the emergency department with splenic injury diagnosed on focused abdominal sonography in trauma (FAST)/contrast enhanced computed tomography (CECT) abdomen. 60 cases were studied over this time-period. After thorough a work-up, patients were either managed conservatively or by surgical intervention. The results were recorded in a predesigned proforma and the statistics were analyzed to determine the outcome of splenic injury patients at DMCH, Ludhiana.Results: Among 10% of cases were Grade-V (American Association for Surgery in Trauma (AAST) grading), all of whom required surgical intervention. 3.3% of cases with lesser grade of injury required surgical intervention due to other reasons. 86.7% were managed conservatively. Mean length of stay was 10.9 days. 83.4% of cases were discharged in stable condition with 13.3% cases being discharged against medical advice and a mortality rate of 3.3%.Conclusions: Majority of patients (86.7%) with splenic injury can be managed conservatively. Surgical intervention is only indicated in patients with Grade-V AAST injury (10%) or in patients with concomitant injury to other organs requiring laparotomy (3.3%). In essence, early diagnosis with FAST and CECT abdomen is the cornerstone in the management of splenic injury, which can help trauma surgeons establish an early management protocol for the better outcome of patients with splenic injury. However, a study with greater sample size is required to further establish the principles of management of splenic trauma in this region.