Blunt splenic injuries: Dedicated trauma surgeons can achieve a high rate of nonoperative success in patients of all ages

Background: Selective nonoperative management (NOM) of blunt splenic injuri es is becoming a more prevalent practice. Inclusion criteria for NOM, which have been a source of controversy, continue to evolve. Age greater than or equal to 55 gears has been proposed as a predictor for failure of and even a contraindication to NOM of blunt splenic trauma, Additionally, the high rate of NOM in children (up to 79%) has been attributed to their management by pediatric surgeons. We evaluated our experience with NOM of blunt splen ic injury with special attention to these age groups. Methods: By using our trauma registry, all patients with blunt splenic inju ries (documented by computed tomography, operative findings, or both) cared for over a 36-month period, at a single American College of Surgeons verif ied Level I trauma center were reviewed. Detailed chart reviews were perfor med to examine admission demographics, laboratory data, radiologic findings , outcome measures, and patient management strategy. All patients were mana ged by nonpediatric trauma surgeons. We then compared our adult data with t hat in the recent literature and our pediatric data with that of the Nation al Pediatric Trauma Registry over the same time period. Results: We identified 251 consecutive patients with blunt splenic injuries . Eighteen patients who expired in the immediate postinjury period were exc luded from statistical evaluation. No deaths occurred as a result of spleni c injury. Of the remaining 233 patients, 73 patients (31%) required early c eliotomy, 160 patients (69%) mere selected for NOM, with 151 patients (94%) being successfully managed without operation. Blunt splenic injury occurre d in 23 patients age 55 years or older, Eighteen patients (78%) were select ed for NOM and 17 patients (94%) were successfully treated without operatio n. Blunt splenic injury occurred in 35 patients less than 16 years of age, Thirty-two patients (91%) were selected for NOM, Thirty-one patients (89% o f all pediatric patients) mere successfully treated without operation. Conclusion: Age greater than or equal to 55 gears is not a contraindication to nonoperative management of blunt splenic injuries. Children with blunt splenic injuries can be successfully managed nonoperatively by nonpediatric trauma surgeons.