Isolated splenic trauma in adults: value of Resciniti's CT scoring system to define the indication for surgery.

The data of 62 adult patients with isolated blunt splenic trauma were retro spectively analysed to determine the value of a CT score-system in the choi ce of treatment nonoperative treatment versus surgical management. 22 patie nts (35 %) without hemodynamic instability presenting with pain localized i n the left flank were primarily managed conservatively. 3 of them subsequen tly required splenectomy. 40 patients (65 %) were operated immediately, 32 on the basis of clinical criteria and 8 on the basis of laboratory criteria . 45 patients with no initial haemodynamic disorders were investigated by a bdominal CT-scan. Splenic injuries were retrospectively classified accordin g to Resciniti's CT-scoring system. 13 patients had a splenic injury score greater than or equal to 5.5. All of them were operated, 11 early and 2 aft er failure of conservative management. According to our study this score gr eater than or equal to 5.5, which concerns 21% of our patients, can be cons idered to be an indication for surgery; in this case, a conservative approa ch should not be at templed, even in the absence of immediate clinical and laboratory operative criteria.