Non‐operative management of isolated splenic trauma: An 11‐year single‐centre retrospective cohort study

Aim The spleen is a frequently injured organ in trauma. There has been a shift into non‐operative management in recent years. At our unit, we follow a protocol established in 2012 for the management of splenic trauma. The primary aim of this study is to investigate whether this protocol increases non‐operative management of splenic trauma, and whether it is safe to follow. The secondary aim is to identify patients at high risk of failing non‐operative management. Patients and Methods We conducted a retrospective cohort study of adult patients with splenic trauma who were admitted into the Queen Elizabeth Hospital between January 1, 2008, and December 31, 2018. Non‐operative management was defined as one in which patients did not have a splenectomy. Isolated splenic injury was defined as splenic injury being the only major intra‐abdominal injury. Patients with intracranial and intrathoracic injuries were included. Patients with iatrogenic injury or incomplete data were excluded. Results There was a statistically significantly increase in patients managed conservatively after protocol establishment (71.4%) compared with before (43.8%; P = .016). Failure of conservative management (P = .71), admission episode death rate (P = .84), red cells transfused in the first 72 hours (P = .85), and length of stay were similar between the preprotocol and postprotocol groups. Risk factors for failure of conservative management were patients with higher injury severity score (P = .003), more red cell transfused in the first 72 hours, high‐energy trauma (P = .018) and American Society of Anesthesiologists grading 3 to 5 (P = .002). Conclusion The protocol established safely allows more spleens to be conserved. We should keep a high vigilance for patients at high risk of failing conservative management.