SPLENIC INJURY - TRENDS IN EVALUATION AND MANAGEMENT

Background: Changing methods of evaluating blunt abdominal trauma and expanding selection criteria for nonoperative management (NOM) of sple nic injury can increase the number of patients managed nonoperatively without affecting success rates. Methods: The charts of 164 patients w ith blunt splenic injuries from July 1, 1991, to June 30, 1996, were r eviewed, Thirty-eight patients mere excluded because of immediate lapa rotomy without adjunctive tests or expiration in the resuscitative per iod, Injuries were graded according to the Organ Injury Scale. Results : Overall, successful NOM occurred in 84% of patients (73 of 87), NOM was successful in 5 of 7 patients >55 years old and in 14 of 15 patien ts with Glasgow Coma Scale scores < 13. Conclusion: Use of computed to mography increased NOM of splenic trauma from 11 to 71% during the 5-y ear period for injuries of equivalent severity, Age > 55 years or abno rmal neurologic status should not preclude NOM, because success was re lated only to injury grade.