Background. The treatment for splenic injury is evolving to an increased us
e of nonoperative management. We studied patients with blunt injury to the
spleen to determine the overall success with splenic salvage and the reason
that adults and children have different outcomes.
Methods, Patient records were reviewed retrospectively for information and
parameters that may influence outcome. Patients were categorized by age and
type of management.
Results. Two hundred sixty-seven patients (222 adults; 45 children < 16 yea
rs old) with blunt splenic trauma were treated over a 7.5 year period. Adul
ts had a significantly higher injury severity score (ISS; 27.2 +/- 0.9 vs 1
9.9 +/- 2.0; P < .05), splenic injury score (SIS; 2.8 +/- 0.1 vs 2.3 +/- 0.
1; P < .01), and mortality rate (11.7% vs 2.2%; P < .05) compared with chil
dren. Eighty-six adults and 3 children had emergent operation; 23 patients
had splenorrhaphy. Nonoperative management was selected initially in 178 pa
tients; 83% (105 adults and 42 children) were treated successfully. The ISS
and SIS of patients in whom nonoperative management failed were different
from those patients in whom treatment was successful (ISS, 27.5 +/- 21 vs 2
0.4 +/- 1.0; SIS, 3.6 +/- 0.2 vs 2.1 +/- 0.1; P < .05) but were similar to
those patients who needed initial emergent operation. Adults and children w
ho had successful nonoperative management had similar ISSs (21.4 +/- 1.1 vs
18.4 +/- 2.0) and SISs (2.0 +/- 0.1 vs 2.3 +/- 0.1). Overall splenic salva
ge was achieved in 64% of patients (57% of adults and 96% of children), Sal
vage increased from 50% to 85% during the study period.
Conclusions. Splenic preservation is possible in most adults and children w
ith blunt injury with the appropriate use of both operative salvage and non
operative treatment. The higher salvage rate and decreased need for operati
on in children is due to their lower severity of overall injury and splenic
injury. Operative salvage has become less common in adults because more pa
tients are selected for nonoperative management.