- Author: P. Renzulli, T. Gross, B. Schnüriger, A. M. Schoepfer, D. Inderbitzin, A. K. Exadaktylos, H. Hoppe, D. Candinas
- Published: Aug 26, 2010
- Pages: 1696-1703
- DOI: 10.1002/bjs.7203
Abstract
Background:
Non‐operative management (NOM) of blunt splenic injuries is nowadays considered the standard treatment. The present study
identified selection criteria for primary operative management (OM) and planned NOM.
Methods:
All adult patients with blunt splenic injuries treated at Berne University Hospital, Switzerland, between 2000 and 2008 were
reviewed.
Results:
There were 206 patients (146 men) with a mean(s.d.) age
of 38·2(19·1) years and an Injury Severity Score of 30·9(11·6). The
American Association for the Surgery of Trauma
classification of the splenic injury was grade 1 in 43 patients (20·9
per cent),
grade 2 in 52 (25·2 per cent), grade 3 in 60 (29·1 per
cent), grade 4 in 42 (20·4 per cent) and grade 5 in nine (4·4 per cent).
Forty‐seven patients (22·8 per cent) required immediate
surgery. Transfusion of at least 5 units of red cells (odds ratio
(OR) 13·72, 95 per cent confidence interval 5·08 to
37·01), Glasgow Coma Scale score below 11 (OR 9·88, 1·77 to 55·16) and
age 55 years or more (OR 3·29, 1·07 to 10·08) were
associated with primary OM. The rate of primary OM decreased from 33·3
to 11·9 per cent after the introduction of transcatheter
arterial embolization in 2005. Overall, 159 patients (77·2 per cent)
qualified for NOM, which was successful in 143 (89·9 per
cent). The splenic salvage rate was 69·4 per cent. In multivariable
analysis age at least 40 years was the only factor
independently related to failure of NOM (OR 13·58, 2·76 to 66·71).
Conclusion:
NOM of blunt splenic injuries has a low failure rate. Advanced age is independently associated with an increased failure rate.
Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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