Traditional criteria for observation of splenic trauma should be challenged

Age less than 55 years, normal Glasgow Coma Score (GCS), and absence of hyp otension are traditional criteria for the selection of adult patients with blunt splenic trauma for observation. The objective of this study is to cha llenge these criteria. Two hundred twelve patients who presented with blunt splenic injury between 1992 and 1997 were identified from the Trauma Regis try at our Level I trauma center. The patients were divided into three grou ps: 100 patients (47%) were observed, 108 (51%) underwent immediate splenor rhaphy or splenectomy, and 4 (2%) failed observation. The three groups were compared by participants' ages, GCSs, and histories of hypotension. No sta tistical differences were noted between the successfully observed patients and those requiring immediate surgery with respect to these criteria. Of th e 4 patients who failed observation, all were younger than 55 years, all ha d a GCS >12, and all were normotensive. Our findings suggest that tradition al criteria used to select patients for splenic trauma observation are not absolute indicators and should be liberalized: patients can be successfully observed despite having criteria that, in the past, would have led to imme diate operative intervention.