[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
July 1990

The Management of Splenic Trauma in a Trauma System

Author Affiliations

From the University of California School of Medicine, San Diego (Dr Molin), and the University of Vermont College of Medicine, Burlington (Dr Shackford).

Arch Surg. 1990;125(7):840-843. doi:10.1001/archsurg.1990.01410190032005
Abstract

• Large teaching centers have reported splenic salvage rates of 40% to 50% in adults after splenic trauma. It is unknown whether similar salvage rates can be achieved safely in community trauma centers with a lower volume of patients and less experience. Between August 1984 and August 1988,117 patients with splenic injury were treated at a level I center and 311 were treated at four level II centers. Splenectomy was performed in 252 patients (59%), splenorrhaphy was performed in 160 patients (37%), and 16 patients (4%) were observed. While the splenic salvage rate was higher at the level I center (50% vs 38%), selective splenorrhaphy was successful in the level II centers where the volume of splenic injury was lower (15 to 25 cases per year).

(Arch Surg. 1990;125:840-843)

References
1.
Shackford SR, Molin MR. Management of splenic injuries. Surg Clin North Am. In press.
2.
Green JB, Shackford SR, Sise MJ, Fridlund PH.  Late septic complications in adults following splenectomy for trauma . J Trauma . 1986;26:999-1004.Article
3.
Pimpl W, Dapunt O, Kaindl H, Thalhamer J.  Incidence of septic and thromboembolic-related deaths after splenectomy in adults . Br J Surg . 1989;76:517-521.Article
4.
Perry JF. Injuries of the spleen. Curr Probl Surg. 1988;25:754-832.Article
5.
Morgenstern L, Shapiro SJ.  Techniques of splenic conservation . Arch Surg . 1979;114:121.Article
6.
Buntain WL, Gould HR.  Splenic trauma in children and techniques of splenic salvage . World J Surg . 1985;9:398-409.Article
7.
Federle MP, Griffith B, Minagi H, Jeffrey RB.  Splenic trauma: evaluation with CT . Radiology . 1987;162:69-71.Article
8.
Meredith JW, Trunkey DD.  CT scanning in acute abdominal injuries . Surg Clin North Am . 1988;68:255-268.
9.
Feliciano DV, Bitondo CG, Mattox KL, Rumisek JD, Burch JM, Jordan GL.  A four year experience with splenectomy versus splenorrhaphy . Ann Surg . 1985;201:568-574.Article
10.
Moore FA, Moore EE, Moore GE, Millikan JS.  Risk of splenic salvage after trauma . Am J Surg . 1984;148:800-805.Article
11.
Mucha P, Daly RC, Farnell MB.  Selective management of blunt splenic trauma . J Trauma . 1986;26:970-979.Article
12.
Gourevitch D, Hadley GP.  Splenic conservation after trauma in children . Surg Gynecol Obstet . 1986;163:536-538.
13.
Kakkasseril JS, Stewart D, Cox JA, Gelfand M.  Changing treatment of pediatric splenic trauma . Arch Surg . 1982;117:758-759.Article
14.
Muehrcke DD, Kim SH, McCabe CJ.  Pediatric splenic trauma: predicting the success of nonoperative therapy . Am JEmerg Med . 1987;5:109-112.Article
15.
Wesson DE, Filler RM, Ein SH, et al.  Ruptured spleen: when to operate? J Pediatr Surg . 1981;16:324-326.Article
16.
Shackford SR, Hollingworth-Fridlund P, Cooper GF, Eastman AB.  The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report . J Trauma . 1986;26:812-817.Article
17.
Champion HR, Sacco WJ, Carnazzo AJ.  Trauma score . Crit Care Med . 1981;9:672-676.Article
18.
Baker SP, O'Neill B, Haddon W, Long WB.  The injury severity score . J Trauma . 1974;14:187-196.Article
19.
Shackford SR, Hollingsworth-Fridlund P, McCardle M, Eastman AB.  Assuring quality in a trauma system—the medical audit committee: composition, cost and results . J Trauma . 1987;27:866-811.Article
20.
Moore EE, Shackford SR, Pachter HL, et al.  Organ injury scaling: spleen, liver, and kidney . J Trauma . 1989;29:1664-1666.Article
21.
Shackford SR, Sise MJ, Virgilio RW, Peters RM.  Evaluation of splenorrhaphy: a grading system for splenic trauma . J Trauma . 1981;21:538-542.Article
22.
Willis BK, Deitch EA, McDonald JC.  The influence of trauma to the spleen on postoperative complications and mortality . J Trauma . 1986;26:1073-1076.Article
23.
Beal SL, Spisso JM.  The risk of splenorrhaphy . Arch Surg . 1988;123:1158-1163.Article
24.
Luna GK, Dellinger EP.  Nonoperative observation therapy for splenic injuries: A safe therapeutic option? Am JSurg . 1987;153:462-468.Article
25.
Cogbill TH, Moore EE, Jurkovich GJ, Morris JA, Mucha P, Shackford SR.  Nonoperative management of blunt splenic trauma: a multi-center experience . J Trauma . 1989;29:1312-1317.Article
×