CHANGING TRENDS IN THE MANAGEMENT OF SPLENIC INJURY

BACKGROUND: A gradual change in the management of splenic injuries has occurred at our institution. This study was therefore undertaken to d etermine whether changes in management of splenic injury influenced ou tcomes during the past 30 years. PATIENTS AND METHODS: A retrospective study of patients admitted with splenic trauma between 1965 and 1994 was performed. Two hundred seven patients were identified and demograp hic and outcome data were recorded. Patients were then grouped based u pon the period in which they received treatment (ie, Period I [1965 to 1974], Period II [1975 to 1984], and Period III [1985 to 1994]) and t he type of treatment received (ie, splenectomy, splenorrhaphy, or obse rvation). RESULTS: More patients were treated in Period III than in th e other two periods, and Period III patients had shorter hospital stay s. Splenectomy was solely used during period I; splenorrhaphy and obse rvation were occasionally performed during Period II; and splenectomy, splenorrhaphy, and observation were performed in near-equal numbers d uring Period III. Mortality was similar for each period, though Injury Severity Scores (ISS) were higher during later years. When compared b y treatment modality, patients receiving splenectomy had higher ISS an d splenic injury classifications. CONCLUSION: Patients treated by sple norrhaphy and observation for splenic injury have markedly increased o ver the past 30 years without adverse outcome.