Rates and predictors of surgery for patients with blunt splenic trauma in a district general hospital of the UK.

OBJECTIVES: To describe the rates of surgery and nonoperative management (NOM) for patients with blunt splenic trauma in a district general hospital.

METHODS: Retrospective review of 20 patients with blunt splenic trauma from 2004 to 2010.

RESULTS: Six patients underwent immediate surgery. Fourteen (70%) patients entered a trial of NOM, of whom three failed the trial (21%) and required surgery. These three patients had significantly lower systolic blood pressures within 60 min of hospital arrival than those who succeeded NOM (90 vs. 113 mmHg, P=0.038). Final management strategy was operative in nine patients and nonoperative in 11 patients. These nine operative patients had significantly higher splenic injury grades, higher Injury Severity Scores and lower 60 min systolic blood pressures than those successfully treated with NOM.

CONCLUSION: Rates of blunt splenic trauma in a district general hospital remain low with acceptable rates of NOM. Hypotension within 60 min of hospital arrival may be a useful predictor of the need for surgery.