Non-operative management in blunt splenic trauma

Background: Splenic preservation following trauma has been decisively established as the preferred, safe and feasible therapeutic modality. Objective: To evaluate the outcomes of non-operative management in adults with blunt splenic injuries and determine the predictive factors of failure. Methods: Patients admitted to a tertiary trauma centre with blunt splenic trauma during a 10 year period were studied retrospectively. They were divided into three groups according to the type of management they received: emergent laparotomy; non-operative management; and those in whom failure of non-operative management led to laparotomy. Patients' age, Glasgow coma score at admission, the spleen injury score, volume of blood transfused, hospitalisation period and number of deaths were the other variables gathered from the records and analysed. Results: 320 consecutive patients were enrolled in the study. A total of 188 ( 58.7%) went directly to the operating room, and 41.2% ( 132 patients) were admitted with the goal of non-operative management for close observation; however, this management failed in 23.4% ( 31 patients) of the cases in the latter group, and laparotomy ( total or partial splenectomy) was the next step. The need for laparotomy increased significantly in cases with higher injury scores. Conclusion: The decision to pursue non-operative management rather than splenic preservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic preservation, particularly in younger, stable patients.