NONOPERATIVE MANAGEMENT OF BLUNT SPLENIC INJURY IN ADULTS - AGE OVER 55 YEARS AS A POWERFUL INDICATOR FOR FAILURE

Selective nonoperative management of adults with blunt splenic injury continues to evolve. Predictive factors associated with successful non operative management have primarily been clinical criteria such as hem odynamic stability and the degree of associated injuries. This study e valuates the role of patient selection in the safety and success of no noperative management of adults with blunt splenic injury. STUDY DESIG N: Herein, we present a retrospective analysis of the management and o utcome of 135 adult (16 years of age or older) patients with blunt spl enic injury at a large urban Level 1 trauma center during a six-year p eriod. RESULT: A total of 46 adult patients were treated nonoperativel y after blunt splenic injury during the study period. Patient ages ran ged from 16 to 93 years (mean, 36.9 years) with 11 patients 55 years o f age or older. Nonoperative management was successful in 24 (52 perce nt) patients. Patients failing nonoperative management were significan tly 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) failu res among younger adults despite similar mean computed tomography sple nic injury grading and Injury Severity Scores (p<0.01). Complications were significantly more prevalent in older patients than in younger pa tients who failed observation (p<0.01). CONCLUSIONS: Nonoperative mana gement of adults with blunt splenic injury commonly fails in older pat ients independent of other clinical and radiographic variables. We con clude that age over 55 years is a contraindication to nonoperative man agement of patients with blunt splenic injury.