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Age Should Not Be a Consideration for Nonoperative Management of Blunt Splenic Injury

Cocanour, Christine S. MD; Moore, Frederick A. MD; Ware, Drue N. MD; Marvin, Robert G. MD; Duke, James H. MD

Journal of Trauma-Injury Infection & Critical Care: April 2000 - Volume 48 - Issue 4 - pp 606-612
Annual Meeting Articles

Background: Operative management of blunt splenic injury is recommended for adults ≥ 55 years. Because this is not our practice, we did a retrospective review to compare outcomes of patients ≥ 55 years old versus patients < 55 years old.

Methods: During a 5-year period ending in July of 1998, 461 patients (3%) admitted to our Level I trauma center had a blunt splenic injury. Eighty-six patients (19%) died within 24 hours of massive injuries, leaving 375 patients for evaluation. Data were obtained from our trauma registry and medical records.

Results: A total of 29 patients (8%) were ≥ 55 years old (mean age, 67 ± 2 years; mean injury severity score [ISS] 25 ± 2). Of these, 18 patients (62%) underwent nonoperative management (NOM). A total of 346 patients (92%) were < 55 years old (mean age, 28 ± 0.6; mean ISS, 20 ± 1). Of these, 198 patients (57%) underwent NOM. The failure rate was not different between the two age groups (17% vs. 14%). However, the ISS and mortality rate were significantly higher in the older age group that failed (ISS, 29.3 ± 2.6 vs. 19.5 ± 2.1; mortality: 67% vs. 4%). None of the deaths could be attributed to splenic injury.

Conclusion: Adults ≥ 55 years old with blunt splenic injury are successfully treated by NOM. Although older adults had significantly greater injuries, they had similar failure rates of NOM when compared with younger adults. Older adults had significantly higher mortality, but this was not a result of their splenic injury. Therefore, age should not be a criteria for NOM of blunt splenic injury.

Nonoperative management (NOM) of splenic injuries is well accepted in both the hemodynamically stable child and young adult. However, there remains controversy as to whether older adults should undergo NOM. As NOM of splenic injury for adults has evolved over the past 15 years, several authors have recommended that patients over the age of 55 be excluded from NOM. 1–4 Because excluding patients from NOM of splenic trauma on the basis of age has not been our practice, we reviewed our experience at a Level I trauma center over the past 5 years to compare outcomes of patients over the age of 55 with patients younger than 55 years old.

From the University of Texas-Houston Medical School, Houston, Texas.

Address for reprints: Christine S. Cocanour, MD, 6431 Fannin, MSB 4.284, Houston, TX 77030.

Submitted for publication September 25, 1999.

Accepted for publication January 10, 2000.

Presented at the 59th Annual Meeting of the American Association for the Surgery of Trauma, September 16–18, 1999, Boston, Massachusetts.

© 2000 Lippincott Williams & Wilkins, Inc.