Protocol-Driven Nonoperative Management in Patients with Blunt Splenic Trauma and Minimal Associated Injury Decreases Length of Stay

BACKGROUND The purpose of this study was to analyze the impact of more selective use of admission angiography combined with protocolized nonoperative management for blunt splenic injury. METHODS This was a retrospective chart review of all patients with splenic injuries and Injury Severity Score < 20 managed by protocol and comparison with a prior matched group managed with admission angiography. RESULTS Forty-three patients were managed under the protocol, with 22 patients treated with admission angiography and the remainder undergoing observation only. Nonoperative salvage was 100% in this group, with a length of stay of 3.3 days. The matched, nonprotocol group had a nonoperative salvage rate of 95%, with a length of stay of 6.8 days. CONCLUSION Protocol-driven management of splenic injury using admission angiography selectively for higher grade splenic injuries led to a decreased length of stay, higher therapeutic yield, and decreased use of hospital resources without any increase in the failure rate of nonoperative management in a selected group of patients with isolated splenic injuries.