230 Five-Year Review of Splenic Injury Management in Major Trauma: Northern Scotland Experience

Abstract Background Splenic trauma is a potentially life-threatening condition and requires timely and appropriate management. North of Scotland trauma team in collaboration with Scottish Trauma Audit Group (STAG), undertook a retrospective review to evaluate patterns of injury, management strategies, and outcomes of splenic trauma. Method Data were collected from trauma calls between January 2019 and December 2023. Of 240 trauma patients reviewed, 72 cases of splenic trauma were identified, with 70 included in the final analysis. Injuries were classified by mechanism (blunt vs. sharp), haemodynamic stability, and severity using the American Association for the Surgery of Trauma (AAST) grading system. Management approaches included non-operative management (NOM), interventional radiology (IR), and surgical intervention. Results 76% patients (53) were male with an age range of 16-87 years (average age 45.5years). The vast majority (97%) sustained blunt trauma. Non-operative management was successfully employed in 48 cases (74%) while 18 patinets (26%) required surgical intervention. The likelihood of NOM failure increased with higher injury grade. Complications observed included delayed splenic rupture, rebleeding, and five readmissions within 30 days. Among surgical group, 11% experienced complications (intra-abdominal collection, adhesion obstruction). A treatment algorithm was developed to guide management based on haemodynamic status and AAST injury grade. Limitations included incomplete data and retrospective challenges in assessing haemodynamic status. Conclusions Structured, multidisciplinary management of splenic trauma, guided by clinical algorithms and grading systems, can optimize patient outcomes. Continued data collection and pathway refinement is ongoing work.