SPLENIC SALVAGE IN ADULTS AT A LEVEL-II COMMUNITY-HOSPITAL TRAUMA CENTER

Recognition of the important role of the spleen within the immune syst em has prompted surgeons to regularly consider splenic preservation. W e studied our experience at a Level II trauma center to determine whet her this trend is reflected in our management. We reviewed 81 adult bl unt trauma patients with splenic injury admitted between January 1988 and December 1993. We examined age, race, and clinical data including mechanism of injury, trauma and injury severity scores, organ injury s cale (OIS) grade, admitting blood pressure, operations, length of stay , hospital charges, and outcome. Thirty-nine patients underwent immedi ate splenectomy. Nonoperative treatment was successful in 31 of 37 pat ients (83.7%). Mean OIS grade (American Association for the Surgery of Trauma) was significantly different between patients treated nonopera tively (1.6 +/- 0.9) and patients treated with immediate splenectomy ( 3.9 +/- 1.1), (P = <0.001). American Association for the Surgery of Tr auma OIS grade correlated well between CT classification and classific ation at operation (r = 0.7, P = 0.0001) but did not predict success i n nonoperative management. Hemodynamic stability, injury severity, and abdominal CT scan findings determine choice of therapy. Splenorrhaphy is frequently discussed but infrequently performed. Splenectomy remai ns the most commonly performed operation for splenic injury in adults with blunt splenic trauma. Nonoperative management is the most common method of splenic salvage at the Level II community hospital trauma ce nter.