DELAYED COMPLICATIONS OF NONOPERATIVE MANAGEMENT OF BLUNT ADULT SPLENIC TRAUMA

Objective: To determine the incidence and type of delayed complication s from nonoperative management of adult splenic injury. Design: Retros pective medical record review. Setting: University teaching hospital, level I trauma center. Patients: Two hundred eighty patients were admi tted to the adult trauma service with blunt splenic injury during a dr -year period. Men constituted 66% of the population. The mean (+/-SEM) age was 32.2+/-1.0 years and the mean (+/-SEM) Injury Severity Score was 22.8+/-0.9. Fifty nine patients (21%) died of multiple injuries wi thin 48 hours and were eliminated from the study. One hundred thirty-f our patients (48%) were treated operatively within the first 48 hours after injury and 87 patients (31%) were managed nonoperatively. Main O utcome Measures: We reviewed the number of units of blood transfused, intensive care unit length of stay, overall length of stay, outcome, a nd complications occurring more than 48 hours after injury directly at tributable to the splenic injury. Results: Patients managed nonoperati vely had a significantly lower Injury Severity Score (P<.05) than pati ents treated operatively. Length of stay was significantly decreased i n both the number of intensive care unit: days as well as total length of stay (P<.05). The number of units of blood transfused was also sig nificantly decreased in patients managed nonoperatively (P<.05). Seven patients (8%) managed nonoperatively developed delayed complications requiring intervention. Five patients had overt bleeding that occurred at 4 days (3 patients), 6 days (1 patient), and 8 days (1 patient) af ter injury. Three patients underwent splenectomy, I had a splenic arte ry pseudoaneurysm embolization, and 1 had 2 areas of bleeding emboliza tion. Two patients developed splenic abscesses at approximately 1 mont h after injury; both were treated by splenectomy. Conclusion: Signific ant numbers of delayed splenic complications do occur with nonoperativ e management of splenic injuries and are potentially life-threatening.