Document Detail

Nonoperative management of blunt splenic injury in adults 55 years and older: a twenty-year experience.
MedLine Citation:
PMID:  10917473     Owner:  NLM     Status:  MEDLINE    
The nonoperative management of splenic injury secondary to blunt trauma in older patients remains controversial. We have reviewed our experience from January 1978 to December 1997 with selective nonoperative management of blunt splenic injury in adults 55 years and older. Criteria for nonoperative management included hemodynamic stability with any transient hypotension corrected using less than 2,000 cm3 crystalloid infusion, a negative abdominal physical examination ruling out associated injuries, and a blood transfusion requirement of no more than 2 units attributable to the splenic injury. During the study period, 18 patients over age 55 with radiographic confirmation of a splenic injury met the above criteria for nonoperative management. Their mean age was 72 years (range 56-86), and 13 of the 18 were female (72%). The mean Injury Severity Score was 15 (range 4-29), with the mechanism of injury equally divided between automobile crashes (9) and falls (9). During a similar time period, 15 patients 55 years or older with splenic injury composed an operative group; these patients did not differ with respect to age (mean 68 years), sex (60% female), or mechanism of injury. CT scans of 8 patients managed nonoperatively were available and graded using the American Association for the Surgery of Trauma classification, with a mean score of 2.3 (range 2-3). Eight of the 18 nonsurgical patients received blood transfusions. None of the 18 patients who met the criteria for nonoperative management "failed" the protocol, and none were taken to the operating room for abdominal exploration. Two patients (11%) died of associated thoracic injuries after lengthy hospital stays, one at 10 days and one at 24 days. We conclude from our data that nonoperative management of blunt splenic injury in patients age 55 years and older is indicated provided they are hemodynamically stable, do not require significant blood transfusion, and have no other associated abdominal injuries.
K R Krause; G A Howells; H A Bair; J L Glover; B L Madrazo; H J Wasvary; P J Bendick
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  66     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-08     Completed Date:  2000-08-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  636-40     Citation Subset:  IM    
Department of Surgery, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
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MeSH Terms
Abdominal Injuries / diagnosis,  therapy*
Age Factors
Injury Severity Score
Medical Records
Middle Aged
Patient Selection
Retrospective Studies
Spleen / injuries*
Treatment Outcome
Wounds, Nonpenetrating / diagnosis,  therapy*

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