Blunt splenic trauma: Analysis of predictors and risk factors affecting the non-operative management failure rate.

BACKGROUND: Non-operative management (NOM) has become a standard treatment in hemodynamically stable patients with blunt splenic trauma. Studies have identified numerous predictors and risk factors for NOM. However, these factors' role in NOM failure continues to be debated. This study aimed to reveal the role of these factors in NOM failure through retrospective analysis of data from patients who underwent non-operative treatment.

METHODS: After the initial evaluation of 189 patients brought to the emergency department between March 2009 and June 2021 and diagnosed with blunt splenic trauma, 13 patients underwent emergency surgery due to hemodynamic instability (immediate splenectomy), and 18 patients who died were excluded from the study. NOM was planned for the remaining 158 patients (stable or stabilized). Patients scheduled for NOM were grouped as either successful NOM (s-NOM; n=139) or failure NOM (f-NOM; n=19) and analyzed the results, retrospectively.

RESULTS: Of the 158 patients scheduled for the NOM, 115 were male. The mean age in s-NOM and f-NOM was 32.2±14.5 versus 36.1±16.1. The mean hospital stay was 8 (4-21) days. The mean follow-up period was 12 (6-18) months. Used USG for 60 (43.2%) patients and CT for 137 (98.6%) in the NOM. The number of Grades I-V in the NOM planned patients (n=158) was 20 (12.6%), 54 (34.1%) 56 (35.4%), 26 (16.4%), and 2 (1.3%), respectively. The success rates according to the Grades I-V were 20 (100%), 52 (96.3%), 52 (92.8%), 15 (57.7%), and 0 (0.0%), respectively. There were 102 units of red cell transfusions administered (mean, 2.46 units) to 41 patients in the s-NOM group, while 81 units (mean, 4.26 units) were administered to 19 patients in the f-NOM group (p=0.001). ISS score >15 was 57.5% (mean score, 22.8) and those in the f-NOM group were 78.9% (mean score, 34.8), respectively (p<0.001). Overall NOM success was 88.0%, total complications were 10.1%, and mortality was 1.2% in this study.

CONCLUSION: Grades I-III blunt splenic trauma patients were successfully treated using the NOM protocol in this study. However, more than half of Grade IV (57.7%) splenic injuries were successfully treated using NOM. Identifying predictors and risk factors based on a standardized plan will likely increase this success.