Management of blunt splenic trauma in patients older than 55 years

Background: Many experts have suggested that blunt splenic trauma in patien ts older than 55 years should not be managed by observation because of supp osed increased fragility of the spleen and decreased physiologic reserve in elderly patients. We sought to determine the outcome of nonoperative manag ement of blunt splenic trauma in patients older than 55 years. Methods: For the years 1994 through 1996, data for patients with splenic in jury older than 55 years from seven trauma centers in a single state were r eviewed. Results: Blunt splenic trauma occurred in 41 patients older than 55 years. Eight patients were excluded from further analysis because of death from ma ssive associated injuries within 24 hours of admission, The remaining 33 pa tients (mean age, 72 +/- 10 years) were divided into two groups: immediate exploration (10 patients) and observation (23 patients), Observation of blu nt splenic injury failed in 4 of 23 patients (17%). No patient deaths were related to the method of management of the splenic injury. Conclusions: Observation of the elderly patient with blunt splenic trauma h as an acceptable failure rate of 17%.