The evolution of blunt splenic injury

Resolution and progression

Stephanie A. Savage, Ben L. Zarzaur, Louis J. Magnotti, Jordan A. Weinberg, George O. Maish, Tiffany K. Bee, Gayle Minard, Thomas Schroeppel, Martin Croce, Timothy Fabian

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND: Nonoperative management of blunt splenic injury (BSI) has become the standard of care for hemodynamically stable patients. Successful nonoperative management raises two related questions: (1) what is the time course for splenic healing and (2) when may patients safely return to usual activities? There is little evidence to guide surgeon recommendations regarding return to full activities. Our hypothesis was that time to healing is related to severity of BSI. METHODS: The trauma registry at a level I trauma center was queried for patients diagnosed with a BSI managed nonoperatively between 2002 and 2007. Follow-up abdominal computed tomography scans were reviewed with attention to progression to healing of BSI. Kaplan-Meier curves were compared for mild (American Association for the Surgery of Trauma grades I-II) and severe (grades III-V) BSI. RESULTS: Six hundred thirty-seven patients (63.9% mild spleen injury and 36.1% severe injury) with a BSI were eligible for analysis. Fifty-one patients had documented healing as inpatients. Ninety-seven patients discharged with BSI had outpatient computed tomography scans. Nine had worsening of BSI as outpatients and two (1 mild and 1 severe) required intervention (2 splenectomies). Thirty-three outpatients were followed to complete healing. Mild injuries had faster mean time to healing compared with severe (12.5 vs. 37.2 days, p < 0.001). Most healing occurred within 2 months but approximately 20% of each group had not healed after 3 months. CONCLUSION: Although mild BSIs heal faster than severe BSIs, nearly 10% of all the BSIs followed as outpatients worsened. Close observation of patients with BSI should continue until healing can be confirmed.

Original languageEnglish (US)
Pages (from-to)1085-1091
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume64
Issue number4
DOIs
StatePublished - Apr 1 2008

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Nonpenetrating Wounds
Outpatients
Wounds and Injuries
Tomography
Trauma Centers
Splenectomy
Standard of Care
Registries
Inpatients
Spleen
Observation

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Savage, S. A., Zarzaur, B. L., Magnotti, L. J., Weinberg, J. A., Maish, G. O., Bee, T. K., ... Fabian, T. (2008). The evolution of blunt splenic injury: Resolution and progression. Journal of Trauma - Injury, Infection and Critical Care, 64(4), 1085-1091. https://doi.org/10.1097/TA.0b013e31816920f1

The evolution of blunt splenic injury : Resolution and progression. / Savage, Stephanie A.; Zarzaur, Ben L.; Magnotti, Louis J.; Weinberg, Jordan A.; Maish, George O.; Bee, Tiffany K.; Minard, Gayle; Schroeppel, Thomas; Croce, Martin; Fabian, Timothy.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 64, No. 4, 01.04.2008, p. 1085-1091.

Research output: Contribution to journalArticle

Savage, SA, Zarzaur, BL, Magnotti, LJ, Weinberg, JA, Maish, GO, Bee, TK, Minard, G, Schroeppel, T, Croce, M & Fabian, T 2008, 'The evolution of blunt splenic injury: Resolution and progression', Journal of Trauma - Injury, Infection and Critical Care, vol. 64, no. 4, pp. 1085-1091. https://doi.org/10.1097/TA.0b013e31816920f1
Savage, Stephanie A. ; Zarzaur, Ben L. ; Magnotti, Louis J. ; Weinberg, Jordan A. ; Maish, George O. ; Bee, Tiffany K. ; Minard, Gayle ; Schroeppel, Thomas ; Croce, Martin ; Fabian, Timothy. / The evolution of blunt splenic injury : Resolution and progression. In: Journal of Trauma - Injury, Infection and Critical Care. 2008 ; Vol. 64, No. 4. pp. 1085-1091.
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AU - Savage, Stephanie A.

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AU - Weinberg, Jordan A.

AU - Maish, George O.

AU - Bee, Tiffany K.

AU - Minard, Gayle

AU - Schroeppel, Thomas

AU - Croce, Martin

AU - Fabian, Timothy

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N2 - BACKGROUND: Nonoperative management of blunt splenic injury (BSI) has become the standard of care for hemodynamically stable patients. Successful nonoperative management raises two related questions: (1) what is the time course for splenic healing and (2) when may patients safely return to usual activities? There is little evidence to guide surgeon recommendations regarding return to full activities. Our hypothesis was that time to healing is related to severity of BSI. METHODS: The trauma registry at a level I trauma center was queried for patients diagnosed with a BSI managed nonoperatively between 2002 and 2007. Follow-up abdominal computed tomography scans were reviewed with attention to progression to healing of BSI. Kaplan-Meier curves were compared for mild (American Association for the Surgery of Trauma grades I-II) and severe (grades III-V) BSI. RESULTS: Six hundred thirty-seven patients (63.9% mild spleen injury and 36.1% severe injury) with a BSI were eligible for analysis. Fifty-one patients had documented healing as inpatients. Ninety-seven patients discharged with BSI had outpatient computed tomography scans. Nine had worsening of BSI as outpatients and two (1 mild and 1 severe) required intervention (2 splenectomies). Thirty-three outpatients were followed to complete healing. Mild injuries had faster mean time to healing compared with severe (12.5 vs. 37.2 days, p < 0.001). Most healing occurred within 2 months but approximately 20% of each group had not healed after 3 months. CONCLUSION: Although mild BSIs heal faster than severe BSIs, nearly 10% of all the BSIs followed as outpatients worsened. Close observation of patients with BSI should continue until healing can be confirmed.

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