Outcome of the current management of splenic injuries

Background: For patients > 55 years, nonoperative management (NOM) of blunt splenic injury remains controversial. Conflicting reports of excessively h igh or acceptably low failure rates have discouraged widespread application of NOM in these older patients. However, the small number of patients in t hese studies limits the impact of their conclusions. Methods: We manage splenic injury nonoperatively in all appropriate patient s without regard to age, We present the largest series of patients > 55 yea rs who have been managed nonsurgically, in a retrospective review of all pa tients with blunt splenic injury admitted to our trauma center between 1996 and 1999. Results: in 4 years, 542 patients were admitted with blunt splenic injury. Eighty-three patients were > 55 years, and 61 of these patients underwent N OM, Seven older patients failed NOM and required delayed splenectomy, yield ing a failure rate of 11.4%. This failure rate was statistically equivalent to the 7% failure rate of patients < 55 years, This study has a power of 8 0% to detect a failure rate change from 7% to 20%. By multivariate analysis , the only factor that significantly increased the risk of NOM failure was splenic injury grade. Patients > 55 years had a higher mortality than young er patients regardless of NOM/operative treatment, Splenic injury did not d irectly cause any of the deaths in patients > 55 years who had NOM or failu re of NOM, High-grade splenic injuries fail NOM in those > 55 years. Conclusion Nonoperative management of lower grade splenic injuries in patie nts > 55 years can be accomplished with an acceptably low failure rate. Onl y grade of splenic injury, not patient age, increases the risk of NOM failu re.