Management Of Splenic Trauma Research Articles

Resultados en el tratamiento de traumatismos esplénicos utilizando un protocolo multidisciplinar en 110 pacientes consecutivos en un hospital de nivel II

IntroductionNon-operative treatment (NOM) of splenic trauma is the management of choice in hemodynamically stable patients. The aim of the present study was to assess the failure rate of NOM after implementation of a multidisciplinary protocol for splenic injuries compared to literature results. MethodsA retrospective study was performed over a 16-year period. Patient data and management of splenic trauma 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), injury grade according to the American Association for the Surgery of Trauma(AAST), failure of NOM, morbidity and mortality. ResultsOne hundred ten 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%) 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 utilized in 56 patients, spleen-preserving surgery in 16, and splenectomy in 38. Ten patients had postoperative complications: seven in the splenectomy group, two in the spleen-preserving surgery group, and one in the NOM group. One patient died. Average hospital stay: 22.8 days- NOM 17.6 days, conservative surgery 29 days, splenectomy 22.4 days. ConclusionsAlthough we continue with a high hospital stay, the literature reports support our results. The implementation of the protocol by consensus contributed to the change towards NOM.

Outcomes in splenic injury at a high volume tertiary care centre

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.

The World Society of Emergency Surgery (WSES) spleen trauma classification: a useful tool in the management of splenic trauma

BackgroundThe World Society of Emergency Surgery (WSES) spleen trauma classification meets the need of an evolution of the current anatomical spleen injury scale considering both the anatomical lesions and their physiologic effect. The aim of the present study is to evaluate the efficacy and trustfulness of the WSES classification as a tool in the decision-making process during spleen trauma management.MethodsMulticenter prospective observational study on adult patients with blunt splenic trauma managed between 2014 and 2016 in two Italian trauma centers (ASST Papa Giovanni XXIII in Bergamo and Sant’Anna University Hospital in Ferrara). Risk factors for operative management at the arrival of the patient and as a definitive treatment were analyzed. Moreover, the association between the different WSES grades of injury and the definitive management was analyzed.ResultsOne hundred twenty-four patients were included. At multivariate analysis, a WSES splenic injury grade IV is a risk factor for the operative management both at the arrival of the patients and as a definitive treatment. WSES splenic injury grade III is a risk factor for angioembolization.ConclusionsThe WSES classification is a good and reliable tool in the decision-making process in splenic trauma management.

The need for red blood cell transfusions in the emergency department as a risk factor for failure of non-operative management of splenic trauma: a multicenter prospective study.

The majority of patients with splenic trauma undergo non-operative management (NOM); around 15% of these cases fail NOM and require surgery. The aim of the current study is to assess whether the hemodynamic status of the patient represents a risk factor for failure of NOM (fNOM) and if this may be considered a relevant factor in the decision-making process, especially in Centers where AE (angioembolization), intensive monitoring and 24-h-operating room are not available. Furthermore, the presence of additional risk factors for fNOM was investigated. This is a multicentre prospective observational study, including patients presenting with blunt splenic trauma older than 17years, managed between 2014 and 2016 in two Italian trauma centres (ASST Papa Giovanni XXIII in Bergamo and Sant'Anna University Hospital in Ferrara-Italy). The risk factors for fNOM were analyzed with univariate and multivariate analyses. In total, 124 patients were included in the study. In univariate analysis, the risk factors for fNOM were AAST grade > 3 (fNOM 37.5% vs 9.1%, p = 0.024), and the need of red blood cell (RBC) transfusion in the emergency department (ED) (fNOM 42.9% vs 8.9%, p = 0.011). Multivariate analysis showed that the only significant risk factor for fNOM was the need for RBC transfusion in the ED (p = 0.049). The current study confirms the contraindication to NOM in case of hemodynamically instability in case of splenic trauma, as indicated by the most recent guidelines; attention should be paid to patients with transient hemodynamic stability, including patients who require transfusion of RBC in the ED. These patients could benefit from AE; in centers where AE, intensive monitoring and an 24-h-operating room are not available, this particular subgroup of patients should probably be treated with operative management.

Conservative Versus Operative Management of Blunt Splenic Injuries

Background: The spleen is the most frequently injured organ in blunt abdominal trauma, mainly because of its highly vascularized parenchyma and its anatomic location. In the past the management of blunt splenic injuries was splenectomy, but high rate of operative complications caused paradigm shift from operative to non-operative management (NOM) in hemodynamically stable blunt abdominal trauma patients. Now, nonoperative management of hemodynamically stable patients with blunt splenic injuries is the standard of care and has been proven to be safe and successful in the acute setting. The advent of newer imaging techniques with high resolution CT scanners has enabled the clinicians to exactly diagnose the extent of intra-abdominal organ injury. Objective: This work aim to compare between operative and conservative management of splenic trauma. Methodology: Total numbers of patients in this study were 20 patients classified in two groups, the first group contained12 patients and the other group contained 8 patients. The First group was managed conservative and the second was managed operative with splenectomy and splenoraphy. The first group of patients consisted of 9 males (75%) and 3 female (25%). The second group of patients consisted of 6 males (75%) and 2 females (25%). Results: In this study, bunt splenic injury was found to be more common in males because of their risky and hard work. RTA and Falling from a height were found to be the most common causes of blunt abdominal injuries. According to CT, grade one and two of splenic injury are more common than other grades of splenic injury. As regard complication the operative management has more complication as postoperative wound infection and postoperative chest infection. So, NOM of splenic injury is the management of choice in haemodynamically stable patients. Conclusion: The nonoperative management is considered the ideal management for blunt splenic injuries due to less complication, less blood transfusion, less hospital stay and less mortality than operative management.

Operative versus conservative management of splenic trauma in pediatric patients

Objective The aim of this study was to compare between operative and conservative management of splenic trauma in pediatric patients. Background In the past the management of blunt splenic injuries was carried out using splenectomy. However, the high rate of operative complications caused a paradigm shift from operative to nonoperative management in hemodynamically stable blunt abdominal trauma patients. Patients and methods This prospective study included a total of 40 patients. The patients were managed conservatively or operatively. Nonoperative management criteria included hemodynamic stability and absence of other injuries requiring laparotomy. Unstable patients were operated using splenectomy. Results Road traffic accident was the most common mechanism of trauma in this study (55%) in the patients who were managed conservatively and (60%) in the patients who were managed operatively (χ2 = 1.507; P = 1.000). Computed tomography was performed for stable patients only; grade I and grade II splenic injury comprised 70% of cases. The incidence of complications was 5% in the patients who were managed conservatively and 10% in the patients who were managed operatively (χ2 = 0.360; P = 1.000). The incidence of blood transfusion was less in the patients who were managed conservatively (25%) than in the patients who were managed operatively (100%) (χ2 = 24.000; P < 0.001). There was no mortality in the patients who were managed conservatively, whereas in the patients who were managed operatively the incidence of mortality was 5% (χ2 = 1.026; P = 1.000). All these tests were used as tests of significance at P less than 0.05. Conclusion The nonoperative management is considered the ideal management for blunt splenic injuries in pediatric patients because of fewer complications, lower blood transfusion rate, shorter hospital stay, and less mortality compared with operative management.

Splenic trauma in a patient with portal hypertension and splenomegaly: A case report

The spleen is the most commonly injured organ in cases of blunt abdominal trauma. Currently, 50-80% of adults with blunt splenic injuries are treated nonoperatively. In this report, we present a blunt abdominal trauma patient having a history of portal hypertension and splenomegaly. In grade 3 and even grade 4 splenic injuries non-operative treatment is recommended in current literature. Management of splenic trauma with a patient with history of splenomegaly and portal hypertension is insufficiently discussed in literature. In presented case, hypersplenism and portal hypertension were burden on hemostasis. Even with massive resuscitation, thrombocyte level decreased to 40.000/mm³ after five hours. But, insistence on non-operative treatment in this situation could be fatal.

Etiology and management of splenic injuries: The experience at Federal Teaching Hospital, Gombe, Northeast Nigeria

Objective: To appraise the current management of splenic trauma with the available resources in our environment and re-emphasizing the role of a sound clinical judgment and early intervention. Methodology: This is a prospective cross-sectional study in which patients that sustained splenic injuries were resuscitated and optimized for laparotomy. Broad spectrum antibiotics and generous analgesia were given. Laparotomy was carried out in all patients and treatment was given according to the grade of injury sustained. Other systemic injuries were co-managed with other subspecialties. Results: Patients in the study were aged 7–52 years (male: female = 3.4:1). The modal age group was 11–20 years. All patients were managed operatively. The majority (51.5%) of splenic trauma in our study were due to vehicular accidents. There was no statistical association between sonographic and intraoperative findings (P = 0.218). Splenectomy was the most common procedure carried out. Complications encountered include surgical site infection (9, 27.3%), respiratory tract infection (6, 18.2%), and deep vein thrombosis (1, 3.0%). The duration of hospital stay for patients was 9–26 days (mean = 12.69 ± 6.30 days). Conclusion: The management of splenic injuries has evolved over the years. The role of a sound clinical judgment is crucial to a successful management outcome, especially in the third world countries.

Temporal changes in hematologic markers after splenectomy, splenic embolization, and observation for trauma.

The spleen is one of the most commonly injured abdominal solid organs during blunt trauma. Modern management of splenic trauma has evolved to include non-operative therapies, including observation and angioembolization to preclude splenectomy in most cases of blunt splenic injury. Despite the shift in management strategies, relatively little is known about the hematologic changes associated with these various modalities. The aim of this study was to determine if there are significant differences in hematologic characteristics over time based on the treatment modality employed following splenic trauma. We hypothesized that alterations seen in hematologic parameters would vary between observation (OBS), embolization (EMB), and splenectomy (SPL) in the setting of splenic injury. An institutional review board-approved, retrospective study of routine hematologic indices examined data between March 2000 and December 2014 at three academic trauma centers. A convenience sample of patients with splenic trauma and admission lengths of stay >96h was selected for inclusion, resulting in a representative sample of each sub-group (OBS, EMB, and SPL). Basic demographics and injury severity data (ISS) were abstracted. Platelet count, red blood cell (RBC) count and RBC indices, and white blood cell (WBC) count with differential were analyzed between the time of admission and a maximum of 1080h (45days) post-injury. Comparisons between OBS, EMB, and SPL groups were then performed using non-parametric statistical testing, with statistical significance set at p<0.05. Data from 130 patients (40 SPL, 40 EMB, and 50 OBS) were analyzed. The median age was 40years, with 67% males. Median ISS was 21.5 (21 for SPL, 19 for EMB, and 22 for OBS, p=n/s) and median Glasgow Coma Scale (GCS) was 15. Median splenic injury grade varied by interventional modality (grade 4 for SPL, 3 for EMB, and 2 for OBS, p<0.05). Inter-group comparisons demonstrated no significant differences in RBC counts. However, mean corpuscular volume (MCV) and RBC distribution width (RDW) were elevated in the SPL and EMB groups (p<0.01). Similarly, EMB and SPL groups had higher platelet counts than the OBS group (p<0.01). In aggregate, WBC counts were highest following SPL, followed by EMB and OBS (p<0.01). Similar trends were noted in neutrophil and monocyte counts (p<0.01), but not in lymphocyte counts (p=n/s). This study describes important trends and patterns among fundamental hematologic parameters following traumatic splenic injuries managed with SPL, EMB, or OBS. As expected, observed WBC counts were highest following SPL, then EMB, and finally OBS. No differences were noted in RBC count between the three groups, but RDW was significantly greater following SPL compared to EMB and OBS. We also found that MCV was highest following OBS, when compared to EMB or SPL. Finally, our data indicate that platelet counts are similarly elevated for both SPL and EMB, when compared to the OBS group. These results provide an important foundation for further research in this still relatively unexplored area.

To Operate or not to Operate, That is the Question! Review of Management of Splenic Trauma in our Institution over the Past 15 Years

To Operate or not to Operate, That is the Question! Review of Management of Splenic Trauma in our Institution over the Past 15 Years

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

Objective: It is crucial to assess non-operative management (NOM) of risk failures before it is preferred as a management option for treatment of splenic trauma or rupture. The purpose of this study is to investigate the outcome of non-operative management of splenic trauma, and to determine the independent predictive factors effecting NOM failure. Material and Methods: Seventy-seven patients among all of consecutive patients admitted with splenic trauma between January 2005 and June 2015 were included in the study. The patients were divided into two groups. Group 1: Successfully treated with non-operative management, and Group 2: The failure of non-operative management. Data recorded included patient demographics, vital signs, injury mechanism, Injury Severity Score (ISS), splenic trauma grade, hematologic parameters, Glasgow Coma Scale (GCS), transfusion requirements, and length of hospital stay. Results: There were 66 (85.7 %) patients in group 1, while only 11 patients (14.3%) in group 2. Mechanism of injury was blunt in seventy-one patients and, penetrating in 6 patients. ISS [Odds Ratio=1.293; 95% CI=1.045-1.601; p=0.018] and blood transfusion [Odds Ratio=2,739; 95% CI= 1.140-6,581; p=0.024] were detected to be an independent predictive factors for the failure of non-operative management. Group 1 has significantly higher hospitalization period (7.73±2.867 vs 6.67±2.289). Conclusions: Non-operative management failure risk is crucial and higher in patients with high ISS and in patients who require much blood transfusion in first 24 hours. Special attention should be paid to these patients if non-operative management becomes the preferred management option.

Abstract No. 345 - Endovascular management of splenic trauma: a review of principles and techniques

1) Discuss the epidemiology and mechanisms of splenic trauma. 2) Review pertinent imaging findings on CT and the American Association for the Surgery of Trauma (AAST) grading scale for splenic injuries. 3) Highlight techniques and principles for endovascular embolization of acute splenic trauma. 4) Discuss follow-up care, post-embolization imaging, and potential complications. Splenic injuries most commonly occur due to blunt force trauma following motor vehicle accidents. While splenic trauma has been historically managed with splenectomy or splenorrhaphy, splenic arterial embolization has become the principal treatment in hemodynamically stable patients. Because of an extensive network of collateral vessels supplying the spleen, proximal or distal embolization maybe employed for endovascular management of splenic injuries. This exhibit reviews the pertinent anatomy and angiographic evaluation of splenic artery embolization. Depending on the initial angiographic findings, proximal or distal embolization maybe performed each with differing techniques and underlying principles. A variety of factors should be considered when choosing the site of embolization as well as the embolic agent utilized. Case based examples of active extravasation, pseudoaneurysms, and splenic artery aneurysms managed with coiling, microparticle, vascular plug, and gel foam embolization will be highlighted using quality images. Close postprocedure care is essential as delayed splenic rupture, splenic abscess, and other complications may occur. Guidelines for vaccination and timing of follow-up CT will be included. Splenic injuries due to blunt force trauma are being increasingly treated with endovascular embolization forgoing the need for operative management. Appropriate utilization of proximal and distal embolization techniques performed with a variety of embolic agents is essential to achieve safe and effective patient outcomes.

Management of splenic trauma: a single institution’s 8-year experience

BackgroundManagement of splenic trauma has evolved, with current practice favoring selective angiographic embolization and non-operative treatment over immediate splenectomy. Defining the optimal selection criteria for the appropriate management strategy remains an important question. MethodsThis retrospective registry review was conducted at a Level I trauma center. The patient population consisted of 20,561 patients in the State Trauma Registry from April 2004 to May 2012. Splenectomy, angiography, splenic embolization, nonoperative, and noninterventional (NI) observation were the management strategies under study. Morbidity and mortality were the outcome measures. Morbidity and mortality by management strategy. ResultsDuring the 8-year study period, 926 (4.5%) patients sustained splenic injury. Observational management increased over time despite the similar distribution of splenic injury grade over the study period: grade I/II (50%), grade III (24.2%), and grade IV/V (25.8%). Mortality rates associated with each management strategy were the following: immediate splenectomy (IS; 25%), splenic embolization (SE; 3.9%), and angiography only or observation, that is, NI (6.5%) management. Injury severity score (ISS) was highest in IS (36.1 ± 1.3) compared with SE (29.1 ± 1.0, P = .001) and NI (21.6, P < .001). Splenectomy was required in 5 of the 129 (3.9%) patients managed with SE and 9 of the 677 (1.3%) patients managed by NI. Mortality was significantly lower among those managed by SE (odds ratio .12, 95% confidence interval: .05 to .32) or NI (odds ratio .21, 95% confidence interval: .12 to .35). This survival benefit was explained by the association of IS with systolic blood pressure <90, high ISS, low GCS at presentation, ISS, development of shock, need for transfusion, and multiorgan failure. ConclusionsIn this large 8-year single institution study, we observed an increase in nonoperative management by an increased application of angiography and embolization. An aggressive utilization of SE in patients with appropriate indications will result in low failure rates and improved mortality.

Results of non-operative management of splenic trauma and its complications in children.

Introduction:Non-operative management (NOM) of splenic trauma in children is currently the treatment of choice.Purpose:We report a series of 83 cases in order to compare our results with literature data.Patients and Methods:For this, we conducted a retrospective study of 13 years and collected 83 cases of children with splenic trauma contusion, managed at Lapeyronie Montpellier Hospital in Visceral Pediatric Surgery Department. The studied parameters were age, sex, circumstances, the blood pressure (BP), hematology, imaging, associated injuries, transfusion requirements, treatment, duration of hospital stay, physical activity restriction and evolution.Results:NOM was successful in 98.7% of cases. We noted 4 complications including 3 pseudo aneurysms (PSA) of splenic artery and 1 pseudocyst spleen with a good prognosis. There was no mortality in our series.Conclusion:NOM is the treatment of choice for splenic trauma in children with a success rate of over 90%. Complications are rare and are dominated by the PSA of splenic artery.

Laparoscopic radiofrequency ablation for traumatic splenic rupture

BackgroundLaparotomy was formerly the routine approach for treating traumatic splenic rupture. Traumatic splenic rupture has traditionally been treated with open splenectomy. The advent of laparoscopy and radiofrequency ablation (RFA) has ushered in new approaches to this surgical problem. The purpose of this study was to evaluate the use of laparoscopic RFA to treat traumatic splenic rupture. MethodsFour patients with traumatic splenic ruptures underwent laparoscopic RFA-assisted spleen-preserving surgery between September 2011 and April 2012. RFA electrodes were used for traumatic rupture repair or partial splenectomies using classic laparoscopic procedures. Safety and efficacy parameters were documented, including surgery time, intraoperative blood loss, postoperative drainage quantities, and recovery conditions. ResultsThree patients received laparoscopic splenic rupture repair and one patient received a partial splenectomy. Three surgeries were successful, based on 1-mo follow-up with computerized tomography and ultrasound examinations that indicated the restoration of satisfactory splenic blood supply. The fourth patient received a laparotomy for a total splenectomy because of massive postoperative bleeding 24 h after surgery. ConclusionsLaparoscopic RFA-assisted spleen-preserving surgery is another modality that may be considered in the management of splenic trauma. This small sample size and limited clinical experience does not justify its use on a routine basis and requires additional clinical research to fully evaluate its efficacy in certain critical traumatic scenarios compared with traditional open splenectomy.

Splenic injury admitted to a rural Level 3 trauma centre: A 10‐year audit

There is paucity of research documenting the management of splenic injury in rural Australia. No data exists for Rural, Remote and Metropolitan Area 4 locations. A retrospective review of prospectively collected data. Records were additionally sought from transfer hospitals. A qualitative assessment of splenic trauma management in the Wimmera Region was also performed. Wimmera Health Care Group: Horsham Campus, a Level 3 trauma hospital between January 2000 and July 2011. Patients coded with injury of spleen or excision procedure on spleen. Nil surgical vs. non-surgical management Nineteen patients were included (mean age 27.8, range 8-54). Only 26% were from Horsham. Most injuries were due to sporting trauma/falls (53%) and motor vehicle accidents (37%). One patient died in theatre from massive trauma. Eleven patients were managed non-operatively. Seven patients had splenectomy performed. Four of these had delay in computed tomography scanning, delay to theatre and suffered major postoperative complication. The age (mean 39.9 versus 20.8) and Injury Severity Score (mean 21.9 versus 13.8) of patients requiring splenectomy was higher than those managed non-operatively. Six of the splenic injury admissions (32%) were transferred from surrounding general practitioner-run Rural, Remote and Metropolitan Area 5 hospitals. All of these patients had Victorian State Trauma Service-defined major trauma with an Injury Severity Score >15. There was an approximate 4-hour delay in transfer of these patients, with transfer occurring when clinical deterioration occurred. Although splenic injury is uncommon in the Wimmera region, improved trauma triaging is required, with early transfer of unstable patients and high-energy trauma mechanisms. A lower threshold for computed tomography scanning is recommended.

Splenocolonic fistula following non-operative management of splenic rupture

Non-operative management has become the preferred treatment for splenic trauma in the absence of haemodynamic instability. The reported complications of non-operative management of splenic trauma may include pseudoaneurysm formation, delayed splenic rupture and splenic abscess formation. Splenocolonic fistula is a finding that has only previously been described in association with Crohn’s disease, pancreatitis, malignancy and haematological disorders. We present the case of a 16-year-old male who suffered a blunt traumatic injury to the spleen, was haemodynamically stable and successfully managed non-operatively. He represented 1 month later following a single episode of per-rectum bleeding. A CT scan of his abdomen revealed a pseudoaneurysm within the spleen, a splenic abscess and a splenocolonic fistula. He proceeded to emergency laparotomy for splenectomy and colonic resection and had an uneventful recovery. The history of management of blunt traumatic splenic injury is discussed, along with the associated risks of operative and conservative management. Methods predicting the success of non-operative management are explored, along with their application and relevance to this particular case.

Temporal Assessment of Splenic Function in Patients Who Have Undergone Percutaneous Image-Guided Splenic Artery Embolization in the Setting of Trauma

Purpose The role of transcatheter splenic arterial embolization (SAE) in the nonoperative management of splenic injury is evolving. The purpose of this study is to evaluate patients who have undergone SAE for laboratory markers of hyposplenism in the years after their procedure. Materials and Methods Thirty-four subjects who had undergone SAE as part of nonoperative management of splenic trauma during a period of 10 years were included. A blood sample was collected from each patient for complete blood count and smear analysis for peripheral markers of hyposplenism (as indicated by Howell–Jolly bodies [HJBs]). Sample size and power analysis was performed, and likelihoods for various true prevalences were calculated. Results The average time interval from procedure to follow-up was 4.4 years. No participants had peripheral markers of hyposplenism or abnormalities in cell count on follow-up. Conclusions Phagocytic function of the spleen in patients who have undergone SAE is preserved, as evidenced by the absence of HJBs on follow-up peripheral blood smears.

Splenic trauma - our experience at a level I Trauma Center

A retrospective study was performed to identify the effect of non -operative management on splenic trauma patients and its implications at our Level I Trauma Centre between January 2007 and June 2008. Data regarding patient demography, mode of splenic injury, computerized tomography (CT) grading, blood transfusion requirement, operative findings, hospital stay, and followup were collected. The results of abdominal sonography and CT scan were utilized as proof of splenic injury and to determine the grade of injury. Subjects were divided into splenectomy and non-operative groups. Results were analyzed using non-parametric Mann-Whitney U tests. Sixty-seven patients were enrolled in this study. All patients with grade I injury and 12 of 13 patients with grade II injury were managed non-operatively, whereas 9 of 16 patients with grade III injuries, 12 of 14 patients with grade IV injuries and all patients with grade V injuries were managed operatively. Thus, the higher the grade of injury, the greater the likelihood of operative management. The mean Injury Severity Score of the operative group was 20.12, significantly higher (p=0.001) than in the non-operative group, at 11.9. Mean hospital stays in the operative and non-operative groups were 12.8 and 8.3 days, respectively. Non-operative management of splenic trauma can be performed with an acceptable outcome.

Controversies in the management of splenic trauma

Background The technologic innovations of the last three decades, coupled with a deeper understanding of the immunologic role of the spleen, have significantly shifted the management of splenic injuries towards non-operative approaches. However, there continuous to be a wide range of practice patterns related to the non-operative management of splenic injuries, from which the authors infer a gap between the best available evidence and its translation into practice. We sought to explore ongoing areas of controversy in the non-operative management of splenic trauma with the aim of further elucidating why these controversies continue to exist. Methods We explored areas of ongoing controversy in the management of splenic injury though a series of iterative surveys. We invited 70 experts in trauma care from ten countries around the world to participate. Areas of controversy explored included: indications and frequency for in-hospital and follow-up imaging, definitions of failure of non-operative management, indications for angioembolisation and non-operative management in special populations (i.e. elderly, concomitant traumatic brain injury, penetrating trauma). Results A 49% response rate was obtained. Even though a wide range of practice patterns were identified, no controversies were identified in areas that do not involve the adoption of new technologies. In areas where practice pattern variation was observed, the strong influence of the local environment was constantly identified as an impediment to changes in practice. Conclusions We have identified that barriers present within local practice environments are the major driving forces behind controversies in the non-operative management of splenic injuries.