Nonoperative management of blunt splenic injury: a rural hospital experience

Aims: Nonoperative management (NOM) of blunt splenic injuries in adults has become a standard approach in hemodynamically stable patients We aimed to investigate the reliability of NOM and the risk factors for failure of NOM. Methods: Included in the present study were 97 patients who underwent NOM for blunt splenic trauma between 2014 and 2022, whose computed tomography (CT) images, treatment, number of transfused erythrocyte suspensions, complications, duration of hospital stay and mortality data were evaluated retrospectively. The cases that underwent laparotomy due to NOM failure (Group OP, n: 20), and those in whom NOM was successful (Group NOM, n: 77) were statistically compared. Results: Among the patients, nine were female and 88 were male, with a mean age of 23.7 years. The CT grade was higher in the OP group than in the NOM group (p: <0.001); the number of patients with multiple organ injuries was significantly higher in the OP group (p: 0.026); the number of ES transfused patients was significantly higher in the OP group (p<0.001); and the duration of hospital stay was longer in the OP group (p<0.001). The CT grade and number of ES transfusions (cut off >0.5 units) were determined as risk factors for NOM failure based on a ROC analysis (p<0.001). There were no differences between the groups in terms of complications, ICU admissions and mortality Conclusion: Non-operative management is a safe and effective protocol in cases of blunt splenic trauma. High grade injury and the quantity of transfused erythrocyte suspensions (>0.5 units) were found to be predictive for NOM failure.