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June 1, 2005

Failure of Nonoperative Management of Splenic Injuries: Causes and Consequences

Author Affiliations

Author Affiliations: The Departments of Surgery (Drs McIntyre and Jurkovich) and Epidemiology (Dr Schiff), University of Washington and the Harborview Injury Prevention Research Center, Seattle.

Arch Surg. 2005;140(6):563-569. doi:10.1001/archsurg.140.6.563

Hypothesis  Presenting patient characteristics can predict which patients will fail nonoperative therapy of blunt splenic injuries.

Design  Retrospective descriptive population study.

Setting  All patients admitted with blunt splenic trauma were identified from a statewide trauma registry between January 1, 1995, and December 31, 2001.

Patients and Methods  Patients were characterized as requiring immediate intervention or successful or failed nonoperative management based on time from emergency department arrival to intervention (surgery or angioembolectomy). Injury and patient characteristics included age, the presence of hypotension, Injury Severity Score, and the Glasgow Coma Scale score. Risk factors for the failure of nonoperative management were evaluated using the χ2 statistic. The failure of nonoperative management associated with the admitting hospital’s trauma designation level was evaluated using logistic regression.

Interventions  None.

Main Outcome Measures  Determine factors associated with failure of nonoperative management of blunt splenic injuries.

Results  Two thousand two hundred forty-three patients met criteria for inclusion in the study. Six hundred ten patients (27%) underwent immediate splenectomy, splenorrhaphy, or splenic embolization (within 4 hours). Of the remaining 1633 patients who were admitted with planned nonoperative management, 252 patients (15%) failed. Of the injury and patient characteristics reviewed, being older than 55 years and having an ISS higher than 25 were significantly associated with failure. Risk of failure also increased with admission to a level III or IV trauma hospital compared with a level I trauma hospital.

Conclusions  Being older than 55 years and having an ISS higher than 25 along with admission to a level III or IV trauma hospital were associated with a significant risk of failure of nonoperative management of splenic injuries. The Glasgow Coma Scale score, associated injuries, and presenting hemodynamics were not predictive of failure in this large retrospective review.