Traditional Criteria for Observation of Splenic Trauma Should be Challenged

• Published in: The American surgeon Vol. 65; no. 7; pp. 689 - 692
• Main Authors: Gaunt, W. Trevor, Mccarthy, Mary C., Lambert, Carie S., Anderson, Gary L., Barney, Linda M., Dunn, Margaret M., Lemmon, Gary W., Paul, Doug B., Peoples, James B.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.07.1999; Southeastern Surgical Congress
• Subjects: Biological and medical sciences; Blood Pressure; Glasgow Coma Scale; Humans; Injuries of the abdomen. Foreign bodies of the digestive system; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Middle Aged; Patient Selection; Spleen - injuries; Spleen - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Traumas. Diseases due to physical agents; Wounds, Nonpenetrating - surgery; Human; Spleen; Indication; Splenic disease; Trauma; Splenectomy; Treatment; Surveillance; Criterion; Abdominal disease; Surgery; Observation; Evolution; Diagnosis
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313489906500716

Age less than 55 years, normal Glasgow Coma Score (GCS), and absence of hypotension are traditional criteria for the selection of adult patients with blunt splenic trauma for observation. The objective of this study is to challenge these criteria. Two hundred twelve patients who presented with blunt splenic injury between 1992 and 1997 were identified from the Trauma Registry at our Level I trauma center. The patients were divided into three groups: 100 patients (47%) were observed, 108 (51%) underwent immediate splenorrhaphy or splenectomy, and 4 (2%) failed observation. The three groups were compared by participants’ ages, GCSs, and histories of hypotension. No statistical differences were noted between the successfully observed patients and those requiring immediate surgery with respect to these criteria. Of the 4 patients who failed observation, all were younger than 55 years, all had a GCS >12, and all were normotensive. Our findings suggest that traditional criteria used to select patients for splenic trauma observation are not absolute indicators and should be liberalized: patients can be successfully observed despite having criteria that, in the past, would have led to immediate operative intervention.