The management of splenic trauma in a trauma system
M. R. Molin and S. R. Shackford
University of California School of Medicine, San Diego.
Large teaching centers have reported splenic salvage rates of 40% to 50% in
adults after splenic trauma. It is unknown whether similar salvage rates
can be achieved safely in community trauma centers with a lower volume of
patients and less experience. Between August 1984 and August 1988, 117
patients with splenic injury were treated at a level I center and 311 were
treated at four level II centers. Splenectomy was performed in 252 patients
(59%), splenorrhaphy was performed in 160 patients (37%), and 16 patients
(4%) were observed. While the splenic salvage rate was higher at the level
I center (50% vs 38%), selective splenorrhaphy was successful in the level
II centers where the volume of splenic injury was lower (15 to 25 cases per
year).
