Nonoperative management of blunt splenic injury in adults: age over 55 years as a powerful indicator for failure

Abstract

Background: Selective nonoperative management of adults with blunt splenic injury continues to evolve. Predictive factors associated with successful nonoperative management have primarily been clinical criteria such as hemodynamic stability and the degree of associated injuries. This study evaluates the role of patient selection in the safety and success of nonoperative management of adults with blunt splenic injury.

Study design: Herein, we present a retrospective analysis of the management and outcome of 135 adult (16 years of age or older) patients with blunt splenic injury at a large urban Level 1 trauma center during a six-year period.

Result: A total of 46 adult patients were treated nonoperatively after blunt splenic injury during the study period. Patient ages ranged from 16 to 93 years (mean, 36.9 years) with 11 patients 55 years of age or older. Nonoperative management was successful in 24 (52 percent) patients. Patients failing nonoperative management were significantly older than patients successfully observed (mean age, 48.1 and 26.7 years, respectively). There were ten (91 percent) failures among the 11 patients 55 years of age or older compared to 12 (34 percent) failures among younger adults despite similar mean computed tomography splenic injury grading and Injury Severity Scores (p < 0.01). Complications were significantly more prevalent in older patients than in younger patients who failed observation (p < 0.01).

Conclusions: Nonoperative management of adults with blunt splenic injury commonly fails in older patients independent of other clinical and radiographic variables. We conclude that age over 55 years is a contraindication to nonoperative management of patients with blunt splenic injury.