Objectives: Evaluation of outcomes of the non-operative management (NOM) of patients who
had a blunt splenic injury (BSI) and the predictors for such outcome.
Patients & Methods: The study included 95, 68, and 61 patients of grades I, II, and III,
respectively, according to the AAST grading of splenic trauma. Patients were evaluated at the
intermediate care unit for trauma extent and severity using the New Injury Severity Scale
(NISS), consciousness using Glasgow Coma scale, hemodynamic status, and gave blood
samples for estimation of hemoglobin concentration (Hb. conc.). Patients who showed
deterioration were shifted either to urgent splenectomy or admitted to ICU. The success rate
of NOM was defined as control of hemodynamic instability if present, stable splenic injury,
the quantity of hemoperitoneum if present with no need for ICU admission for any indication,
and survival rate of patients who had succeeded or failed NOM.
Results: During NOM, 29 patients were admitted to ICU, 21 patients underwent urgent
splenectomy and two patients deceased. Fifteen of patients admitted to ICU completed their
NOM uneventfully and 5 patients underwent elective splenectomy, while 9 patients were
deceased. Five of the 26 patients who underwent splenectomy died. The total survival rate was
92.9%; 187 patients completed NOM (94.4%) and 21 had surgery (80.8%) with a significant
difference in favor of NOM. Statistical analyses defined high at admission Hb. conc., young
age, normal SBP, low NISS score, and low AAST grade were the predictors for NOM success
with decreasing order of importance. Kaplan-Meier regression analysis defined SBP at 106 and
104 mmHg as the cutoff points for the probability of NOM success and survival.
Conclusion: Proper selection of BSI patients allowed a high success rate (83.5%) and survival
rate (94.4%) of NOM. Young aged patients with low NISS scores and high SBP and
hemoglobin concentration are the ideal candidate for NOM with suspected high success and
survival rates, irrespective of injury grade. High SBP and low NISS scores are the best
predictors with high positive predictive value and sensitivity for the success of NOM. |
