Management of adult splenic injuries in Ontario: A population-based study

OBJECTIVES: To determine the population-based incidence of splenic injuries in the Province of Ontario, the proportion of splenic injuries treated by observation, splenectomy and splenorrhaphy, changes in management over time and the variation in management of splenic injuries among Ontario hospital s. DESIGN: A retrospective cohort study. PATIENTS: All adults (older than 16 years) admitted with a diagnosis of spl enic injury (clinical modification of the International Classification of D iseases, 9th revision) to acute care hospitals in Ontario between 1991 and 1994, identified from the Ontario Trauma Registry. RESULTS: The incidence of splenic injury was 1.7 cases per 1000 trauma admi ssions per year. Patients with splenic injury were young (median age 32 yea rs) and male (71%), and the death rate was 8%. Observation was the commones t method of treatment (69%), followed by splenectomy (28%) and splenorrhaph y (4%). The use of observation increased over the study period from 59% to 75% (p < 0.001). There was significant variation in the use of observation among hospitals (range 11% to 100%, p < 0.0001). CONCLUSIONS: The majority of splenic injuries are managed by observation wi th an acceptable hospital death rate. The use of observation has increased over time, confirming the growing adoption of this management approach by m ost hospitals in the province when feasible. Splenorrhaphy was infrequently per formed despite reports to the contrary from many centres in the United States. There was significant variation in splenic injury management, sugg esting the need for further refinement and dissemination of practical guide lines for splenic salvage.