Original communication| Volume 142, ISSUE 3, P337-342, September 2007

Early discharge after nonoperative management for splenic injuries: increased patient risk caused by late failure?


      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.


      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.


      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.


      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baudet R.
        Ruptures de la rate.
        Medicine Practique. 1907; 3: 565
        • el Rifi K.
        The latent period of Baudet.
        Br J Surg. 1967; 54: 238-239
        • McIndoe A.
        Delayed hemorrhage following traumatic rupture of the spleen.
        Br J Surg. 1932; 20: 249-267
        • Sizer J.S.
        • Wayne E.R.
        • Frederick P.L.
        Delayed rupture of the spleen.
        Arch Surg. 1966; 92: 362-366
        • Zabinski E.
        • Harkins H.
        Delayed splenic Rupture.
        Arch Surg. 1943; 46: 186-213
        • Olsen W.R.
        • Polley Jr, T.Z.
        A second look at delayed splenic rupture.
        Arch Surg. 1977; 112: 422-425
        • Cogbill T.H.
        • Moore E.E.
        • Jurkovich G.J.
        • Morris J.A.
        • Mucha Jr, P.
        • Shackford S.R.
        • et al.
        Nonoperative management of blunt splenic trauma: a multicenter experience.
        J Trauma. 1989; 29: 1312-1317
        • Peitzman A.B.
        • Heil B.
        • Rivera L.
        • Federle M.B.
        • Harbrecht B.G.
        • Clancy K.D.
        • et al.
        Blunt splenic injury in adults: multi-institutional Study of the Eastern Association for the Surgery of Trauma.
        J Trauma. 2000; 49 (discussion 87-9): 177-187
        • Farhat G.A.
        • Abdu R.A.
        • Vanek V.W.
        Delayed splenic rupture: real or imaginary?.
        Am Surg. 1992; 58: 340-345
        • Cocanour C.S.
        • Moore F.A.
        • Ware D.N.
        • Marvin R.G.
        • Clark J.M.
        • Duke J.H.
        Delayed complications of nonoperative management of blunt adult splenic trauma.
        Arch Surg. 1998; 133 (discussion 24-5): 619-624
        • Barone J.E.
        • Burns G.
        • Svehlak S.A.
        • Tucker J.B.
        • Bell T.
        • Korwin S.
        • et al.
        Management of blunt splenic trauma in patients older than 55 years.
        J Trauma. 1999; 46: 87-90
        • Pachter H.L.
        • Guth A.A.
        • Hofstetter S.R.
        • Spencer F.C.
        Changing patterns in the management of splenic trauma: the impact of nonoperative management.
        Ann Surg. 1998; 227 (discussion 17-9): 708-717
        • Parithivel V.S.
        • Sajja S.B.
        • Basu A.
        • Schein M.
        • Gerst P.H.
        Delayed presentation of splenic injury: still a common syndrome.
        Int Surg. 2002; 87: 120-124
        • Kluger Y.
        • Paul D.B.
        • Raves J.J.
        • Fonda M.
        • Young J.C.
        • Townsend R.N.
        • et al.
        Delayed rupture of the spleen–myths, facts, and their importance: case reports and literature review.
        J Trauma. 1994; 36: 568-571
        • Williams R.A.
        • Black J.J.
        • Sinow R.M.
        • Wilson S.E.
        Computed tomography-assisted management of splenic trauma.
        Am J Surg. 1997; 174: 276-279
        • Hiraide A.
        • Yamamoto H.
        • Yahata K.
        • Yoshioka T.
        • Sugimoto T.
        Delayed rupture of the spleen caused by an intrasplenic pseudoaneurysm following blunt trauma: case report.
        J Trauma. 1994; 36: 743-744
        • Norotsky M.C.
        • Rogers F.B.
        • Shackford S.R.
        Delayed presentation of splenic artery pseudoaneurysms following blunt abdominal trauma: case reports.
        J Trauma. 1995; 38: 444-447
        • Haan J.
        • Scott J.
        • Boyd-Kranis R.L.
        • Ho S.
        • Kramer M.
        • Scalea T.M.
        Admission angiography for blunt splenic injury: advantages and pitfalls.
        J Trauma. 2001; 51: 1161-1165
        • Davis K.A.
        • Fabian T.C.
        • Croce M.A.
        • Gavant M.L.
        • Flick P.A.
        • Minard G.
        • et al.
        Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms.
        J Trauma. 1998; 44 (discussion 13-5): 1008-1013
        • Velmahos G.C.
        • Chan L.S.
        • Kamel E.
        • Murray J.A.
        • Yassa N.
        • Kahaku D.
        • et al.
        Nonoperative management of splenic injuries: have we gone too far?.
        Arch Surg. 2000; 135 (discussion 9-81): 674-679
        • Velmahos G.C.
        • Toutouzas K.G.
        • Radin R.
        • Chan L.
        • Demetriades D.
        Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study.
        Arch Surg. 2003; 138: 844-851