Splenic injury: Trends in evaluation and management

Background: Changing methods of evaluating blunt abdominal trauma and expanding selection criteria for nonoperative management (NOM) of splenic injury can increase the number of patients managed nonoperatively without affecting success rates. Methods: The charts of 164 patients with blunt splenic injuries from July 1, 1991, to June 30, 1996, were reviewed. Thirty- eight patients were excluded because of immediate laparotomy without adjunctive tests or expiration in the resuscitative period. Injuries were graded according to the Organ Injury Scale. Results: Overall, successful NOM occurred in 84% of patients (73 of 87). NOM was successful in 5 of 7 patients >55 years old and in 14 of 15 patients with Glasgow Coma Scale scores < 13. Conclusion: Use of computed tomography increased NOM of splenic trauma from 11 to 71% during the 5-year period for injuries of equivalent severity. Age > 55 years or abnormal neurologic status should not preclude NOM, because success was related only to injury grade.