Non-operative management of isolated splenic trauma: An 11-year single-centre retrospective cohort study

Aim: The spleen is a frequently injured organ in trauma. There has been a shift into non-operative management in recent years. At our unit, we follow a protocol established in 2012 for the management of splenic trauma. The primary aim of this study is to investigate whether this protocol increases non-operative management of splenic trauma, and whether it is safe to follow. The secondary aim is to identify patients at high risk of failing non-operative management. Patients and Methods: We conducted a retrospective cohort study of adult patients with splenic trauma who were admitted into the Queen Elizabeth Hospital between January 1, 2008, and December 31, 2018. Non-operative management was defined as one in which patients did not have a splenectomy. Isolated splenic injury was defined as splenic injury being the only major intra-abdominal injury. Patients with intracranial and intrathoracic injuries were included. Patients with iatrogenic injury or incomplete data were excluded. Results: There was a statistically significantly increase in patients managed conservatively after protocol establishment (71.4%) compared with before (43.8%; P = .016). Failure of conservative management (P = .71), admission episode death rate (P = .84), red cells transfused in the first 72 hours (P = .85), and length of stay were similar between the preprotocol and postprotocol groups. Risk factors for failure of conservative management were patients with higher injury severity score (P = .003), more red cell transfused in the first 72 hours, high-energy trauma (P =.018) and American Society of Anesthesiologists grading 3 to 5 (P = .002). Conclusion: The protocol established safely allows more spleens to be conserved. We should keep a high vigilance for patients at high risk of failing conservative management.