BLUNT SPLENIC TRAUMA - CHARACTERISTICS OF PATIENTS REQUIRING URGENT LAPAROTOMY

In victims of blunt abdominal trauma, the spleen is the most common or gan damaged, is the most likely source of serious injury, and is assoc iated with significant morbidity and mortality. The participants in th is study were emergency department (ED) patients with splenic trauma d etermined via imaging study, surgical exploration, or autopsy. Patient s were located using both the institution's trauma registry and discha rge diagnoses (ICD-9 codes) involving splenic injury resulting from bl unt trauma. Medical records including pre-hospital, ED, and hospital i nformation were reviewed. Chi Square and Fisher's exact test were used for statistical analysis where appropriate, with a P value of less th an 0.05 considered significant. Fifty-five patients (60% male) were an alyzed with a mean age of 31 years (range, 1 to 78 years). Sixteen (30 %) patients (mean age 44 years) were managed operatively, with 14 pati ents receiving only a diagnostic peritoneal lavage. All 38 patients (7 0%, mean age 26 years) who received nonoperative management were diagn osed by computed tomography. The motor vehicle crash represented the m ost frequent mechanism of injury in both groups; the nonoperative grou p, however, experienced other injury mechanisms more frequently. Clini cal variables suggestive of the need for urgent surgical intervention (from ED to the surgical suite) include hypotension (systolic blood pr essure less than 90 mm/Hg) in the pre-hospital setting or ED; tachycar dia (heart rate greater than 100 beats/min) in the ED; abnormal hemato crit (less than 30) or coagulopathy (prothrombin time greater than 14 seconds) in the ED; multiple injuries; or blood transfusion in the ED. Complaints of pain resulting from traumatic injury and abdominal exam ination findings did not identify patients requiring urgent operative management. Hemodynamic instability, evidence of multiple injuries, ab normal laboratory parameters, and the requirement for blood transfusio n in the ED identifies a patient population likely to require operativ e therapy of their splenic injury. Emergency physicians should conside r early surgical consultation or urgent transfer to the regional traum a center in patients with these characteristics.