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Observation For Nonoperative Management of the Spleen: How Long is Long Enough?

McCray, Victor W. MD; Davis, James W. MD; Lemaster, Deborah RN; Parks, Steven N. MD

Journal of Trauma and Acute Care Surgery: December 2008 - Volume 65 - Issue 6 - p 1354-1358
doi: 10.1097/TA.0b013e31818e8fde
Original Articles

Background: Nonoperative management of splenic injury is common with reported success rates between 83% and 97%. However, there are no specific protocols for nonoperative observation published in the literature. The purpose of this study is to analyze the safety and effectiveness of our institutional guideline for observation of patients managed nonoperatively for splenic injury.

Methods: A retrospective registry and chart review was conducted for all patients with splenic injury who were admitted for nonoperative management (NOM). Our guideline for observation is admission with bed rest, serial hemoglobins every 6 hour, and discharge when hemoglobin is stable. Data collected for this study was age, gender, Injury Severity Score, grade of splenic injury, length of stay, NOM failures while in hospital and readmissions after discharge for nonoperative failure.

Results: From August 2002 through June 2007, 449 patients were admitted for NOM of splenic injury. Sixteen (4%) patients failed NOM and went to the operating room for splenectomy.

Conclusions: NOM of blunt splenic injuries had a 96% success rate following our protocol. The guideline successfully identified all the patients failing NOM during the inpatient observation period with the exception of one patient that was noncompliant to protocol. This guideline for observation is safe and effective.

From the Department of Surgery (V.W.M., J.W.D., D.L., S.N.P.), UCSF-Fresno, Community Regional Medical Center, Fresno, California.

Submitted for publication February 26, 2008

Accepted for publication September 19, 2008.

Presented at the 38th Annual Meeting of the Western Trauma Association, February 24–March 1, 2008, Squaw Creek, Olympic Valley, California.

Address for reprints: Victor W. McCray, MD, Community Regional Medical Center, 2823 Fresno Street, Fresno, CA 93721; email:

© 2008 Lippincott Williams & Wilkins, Inc.