Blunt splenic injury: authors' experience and comparison to literature

Abstract

Aim: Splenic injuries, like other blunt traumatic injuries, are very frequent, especially in case of traffic accident. The purpose of this study was to present the authors' experience of blunt splenic trauma and to compare it with the studies described in literature.

Methods: Over a 5-year period 512 injured patients were admitted to the trauma center, 57 of whom presented splenic injuries, and they were retrospectively analyzed. Data review included demographic information, trauma mechanism, admitting hemodinamic parameters, Injury Severity Score. The patients were classified in two groups, one composed by immediate operated injured because their initially hemodinamic instability (27 patients) and another where patients underwent planned nonoperative management (29 patients), which included strict bed rest, frequent physical examinations, serial hematocrits and repeated diagnostic images. The patients were compared to find which factors influence the choice of surgical treatment.

Results: There are statistically significant differences between the groups, concerning admitting hemodinamic parameters, as blood pressure and pulse rate, and the grade of anatomic splenic injury. Four patients failed nonsurgical management and required a splenectomy, because during the third day they suddenly presented clinical deterioration.

Conclusions: Comparing these results with literature the authors try to improve spleen preserving program avoiding surgery when possible and using for example splenic embolization.