Afshin Parsikia, MD, MPH
Director of Surgical Research
Einstein Healthcare Network, United States
Disclosure information not submitted.
William Ketchum
Albert Einstein Medical Center
Philadelphia, Pennsylvania
Disclosure information not submitted.
Samantha Olafson, MD
Surgical Resident
Einstein Healthcare Network, United States
Disclosure information not submitted.
Landon Fougler, MD
Mr.
Pennsylvania College of Osteopathic Medicine, United States
Disclosure information not submitted.
Pak Leung, MD
Doctor
Albert Einstein medical center, United States
Disclosure information not submitted.
Benjamin Moran, MD
Assistant Professor of Surgery
Albert Einstein Medical Center, United States
Disclosure information not submitted.
Mark Kaplan, MD
Chair of Trauma and Surgical Critical Care
Einstein Medical Center Philadelphia, United States
Disclosure information not submitted.
Title: Operative vs. Non-Operative Management of Mild Splenic Injury - Einstein Experience
Introduction/hypothesis: In recent years, data has supported the use of non-operative management (NOM) in hemodynamically stable patients presenting with an isolated splenic injury without evidence of peritonitis. There still exists a subset of patients that fail NOM, and the predicting factors remain unclear. The goal of this study is to identify factors that would allow early detection of failure of non-operative management in patients with low grade splenic injuries.
Methods: Institutional data for blunt splenic injury from 10/1/2010 to 10/1/2020 was examined. Patients with grade I splenic injury were isolated with the relevant ICD-9/ICD-10 codes, identifying 31 patients. Patient records were used to review CT scans and patient data. 9 patients did not have a significant splenic injury or had a grade of injury greater than 1 and were excluded. The remaining 22 patients were included in the study.
Results: Of 22 patients examined, 81.8% (n=18) of low-grade splenic injuries did not require surgery. For those that required splenectomy (n = 4, 18.2%), initial hemoglobin on admission was 11.2 (median). Low minimum hemoglobin over the first 48 hours of admission (median 6.9 g/dl, IQR 6.2 – 7.75 g/dl), regardless of subsequent transfusions, was correlated with higher likelihood of splenectomy (p = 0.019). Low presenting SBP (median 95.5 mmHg, IQR 73-119.5) was borderline predictive of non-operative management (p = 0.061). Longer lengths of stay (median 9.5 days, IQR 8.5 – 23 days) were noted in those who failed initial NOM (p = 0.011). Other factors taken into account that were not statistically significant were increased age (p = 0.30), male gender (p = 0.27), transfusion of greater than 1 unit of PRBC (p =0.20), Splenic artery embolization (p = 0.46), peri-splenic hematoma, and associated injuries including left rib fracture, right rib fracture, liver injury, and other intrabdominal injuries, (p = 0.26, 0.63, 0.70, 0.84, respectively).
Conclusions: In patients with grade I splenic injuries who undergo NOM, patients with decrease in hemoglobin to less than 8 g/dl after 48 hrs are more likely to fail NOM and require splenectomy. Low systolic blood pressure on admission may also play a roll in predicting failure of NOM. Initial NOM patients who later require splenectomy require longer lengths of stay in the hospital.