Johannes Wiik Larsen (Stavanger / NO), Kjetil Søreide (Stavanger / NO), Jon Arne Søreide (Stavanger / NO), Lars Fjetland (Stavanger / NO), Kenneth Thorsen (Stavanger / NO)
Abstract text (incl. references and figure legends)
Introduction: Splenic injuries are common in abdominal trauma patients. Several changes to the trauma system have contributed to current management strategies. Non-Operative Management (NOM) with radiological interventions is preferred when possible. This study investigates demographics, management, and mortality of patients with splenic injuries during our trauma registry's initial 15 years of registration.
Material & Methods: A retrospective observational cohort study of data recorded prospectively at Stavanger University Hospital's Trauma Registry between January 2004 and December 2018. Patients with Abbreviated Injury Scale (AIS) code for splenic injury were included.
Results: A total of 135 patients (median age 23 years; males 74%) had a splenic injury, predominantly from blunt trauma (99%). A splenic injury occurred in 1.9% of all trauma patients, and in 30% of patients with abdominal injuries. Over half (55%) had polytrauma, with median ISS=25 and median NISS=29. Two-thirds had a severe splenic injury (AIS score ³3), distributed across OIS III at 34%, OIS IV at 22%, and OIS V at 8%, respectively. OIS I and II represented 36% of the injuries. Splenic injury as a single abdominal injury was seen in 54% of the patients. Associated injuries in other body regions were found in 87%, most frequently in the thoracic region (70%). NOM was chosen in 105 patients (78%) with a 4%(4/105) failure rate. Of the 30 surgically treated patients, 14 had a splenectomy, and 16 had spleen-preserving measures (with one delayed splenectomy). Angioembolization was done in 25%(34/135) of the patients. With an overall 30-day mortality of 6%, no further deaths occurred within 90 days after the incident.
Conclusion: Splenic injuries are characterized by blunt injuries in young males resulting in a high-grade injury in two-thirds of the patients. NOM showed a low failure rate, and splenectomy-rate was 11%. Mortality was rare, with only three deaths attributed to uncontrollable bleeding.
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