SP9.1 Increasing use of non-operative management in high grade splenic trauma

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Abstract Aims The aim was to review the success of non-operative management (NOM) in the management of splenic trauma at our Major Trauma Centre (MTC). Methods We performed a retrospective data collection of all adults presenting to a London MTC with radiological evidence of splenic injury between 2014 and 2021. Electronic patient records were reviewed. Splenic injury was graded by a consultant radiologist. Patients too unstable to undergo a pre-operative CT for radiological injury grading were excluded from the analysis. Results Data was available for 337 patients, of which 28 patients went straight to theatre without imaging. 234 (75.7%) patients had AAST grade I-III splenic injury, 52 (16.8%) had grade IV and 23 (7.4%) had grade V injury. Successful NOM was achieved in 88.5% of patients with grade I-III splenic injury, 78.8% grade IV and 26.1% grade V injury. Patients with grade IV injury were more likely to undergo NOM without embolisation compared to grade V injury (OR=13.14, p=0.00058). The proportion of NOM grade IV injury increased significantly from 2017 to 2021 (OR= 16.94, p=0.001). There was also a significant difference between the rate of successful embolisation between grade IV and V splenic injury (OR=9.27, p=0.0003). Of patients undergoing operative management, grade I-III patients had a significantly higher chance of spleen salvage compared to grade IV-V patients (OR=34.5, p<0.00001). Conclusions This data demonstrates our increasing confidence in NOM for successful management of high-grade (IV-V) splenic trauma. Further research is required to identify specific patient characteristics associated with successful use of NOM.