Non-operative management of low-grade (grade I–II) splenic injury in hemodynamically stable adults

Blunt splenic injury (BSI) commonly managed without surgery in hemodynamically stable (HDS) patients. This systematic review aimed to evaluate the outcomes of non-operative management (NOM) in adults with grade I–II BSI. A literature search was conducted in PubMed, Scopus, Web of Science, and Embase using search terms related to splenic trauma, blunt splenic injury, conservative treatment, observation, and NOM. Original studies which include adults with low-grade splenic injury managed non-operatively were eligible. We extract data on study design, patient characteristics, management approach, success or failure of NOM, delayed intervention, complications, transfusion requirement, and hospital stay, then this extracted data was synthesized narratively. Eight studies published between 1989 and 2024 were included. The findings showed a high success rate of NOM in HDS adults with grade I–II injury. Failure in low-grade injury was rare and occurred usually early after admission. Failure was associated with worsening hemodynamic condition, higher transfusion need, increasing abdominal signs, and greater trauma burden. Patients with contrast extravasation represented a higher-risk subgroup, with one study showing a 20% failure rate. We conclude that NOM is effective for low-grade BSI in stable adults, and careful monitoring is important, when vascular blush or early clinical deterioration is present.