Outcome of the current management of splenic injuries

Jeffrey A. Nix, Michael Costanza, Brian Daley, Melissa A. Powell, Blaine Enderson

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Background: For patients > 55 years, nonoperative management (NOM) of blunt splenic injury remains controversial. Conflicting reports of excessively high or acceptably low failure rates have discouraged widespread application of NOM in these older patients. However, the small number of patients in these studies limits the impact of their conclusions. Methods: We manage splenic injury nonoperatively in all appropriate patients without regard to age. We present the largest series of patients > 55 years who have been managed nonsurgically, in a retrospective review of all patients with blunt splenic injury admitted to our trauma center between 1996 and 1999. Results: In 4 years, 542 patients were admitted with blunt splenic injury. Eighty-three patients were > 55 years, and 61 of these patients underwent NOM. Seven older patients failed NOM and required delayed splenectomy, yielding a failure rate of 11.4%. This failure rate was statistically equivalent to the 7% failure rate of patients < 55 years. This study has a power of 80% to detect a failure rate change from 7% to 20%. By multivariate analysis, the only factor that significantly increased the risk of NOM failure was splenic injury grade. Patients > 55 years had a higher mortality than younger patients regardless of NOM/operative treatment. Splenic injury did not directly cause any of the deaths in patients > 55 years who had NOM or failure of NOM. High-grade splenic injuries fail NOM in those > 55 years. Conclusion: Nonoperative management of lower grade splenic injuries in patients > 55 years can be accomplished with an acceptably low failure rate. Only grade of splenic injury, not patient age, increases the risk of NOM failure.

Original languageEnglish (US)
Pages (from-to)835-842
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume50
Issue number5
DOIs
StatePublished - Jan 1 2001

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Wounds and Injuries
Nonpenetrating Wounds
Trauma Centers
Risk Management
Splenectomy
Cause of Death
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Outcome of the current management of splenic injuries. / Nix, Jeffrey A.; Costanza, Michael; Daley, Brian; Powell, Melissa A.; Enderson, Blaine.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 50, No. 5, 01.01.2001, p. 835-842.

Research output: Contribution to journalArticle

Nix, Jeffrey A. ; Costanza, Michael ; Daley, Brian ; Powell, Melissa A. ; Enderson, Blaine. / Outcome of the current management of splenic injuries. In: Journal of Trauma - Injury, Infection and Critical Care. 2001 ; Vol. 50, No. 5. pp. 835-842.
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