Background
With increasing experience and knowledge about nonoperative management of splenic
injury (NOMSI), patients are being discharged early and possibly placed at risk for
late failure of NOMSI and its associated complications. To evaluate if blunt trauma
patients managed by NOMSI can be safely discharged early, because failure after the
third day from injury occurs infrequently and is not associated with added morbidity.
Methods
The medical records of patients who failed NOMSI from January 1993 to December 2005
in an academic level 1 trauma center were reviewed. Patients who failed NOMSI within
3 days (early failure) were compared with patients who failed it after 3 days (late
failure) to identify characteristics that may help predict late failure. Primary outcomes
were complications and death related to late failure.
Results
Of 691 patients admitted with blunt trauma to the spleen, 499 (72%) had NOMSI and
36 (7%) failed it. Early failure was recorded in 26 patients (5%) and late failure
in 10 (2%). Late bleeding was the cause of failure in all patients with late failure
and occurred in 8 ± 6 (mean ± SD) days after admission (4-8 days in 7 patients and
12-22 days in 3). When comparing age, Injury Severity Score, hemotocrit on admission,
preoperative blood transfusions, and grade of splenic injury, no differences were
found between patients with early and late failure. All but 1 patient with late failure
were still in the hospital for associated injuries at the time of failure. No patient
died, had delayed diagnosis, or suffered added morbidity because of late failure.
Conclusion
Late failure occurs infrequently, unpredictably, and almost always in patients who
are still in the hospital for associated injuries. In-hospital observation beyond
the third day after injury is not necessary for most patients with splenic injury,
who have no other reason to remain hospitalized.
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Article info
Publication history
Accepted:
May 5,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
