This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Lauren P. Archer, MD; Frederick B. Rogers, MD; Steven R. Shackford, MD

Arch Surg. 1996;131(3):309-315.

Abstract
Background
Nonoperative management of blunt liver and spleen injuries in hemodynamically stable, neurologically intact patients has become an accepted treatment in recent years.

Objective
To determine the morbidity and mortality in neurologically impaired adult patients who had sustained blunt liver or spleen injuries and who had been managed nonoperatively in a monitored setting, owing to the preponderance of blunt trauma and associated head injuries in Vermont.

Design
Case-control study.

Setting
Regional level I trauma center in northern Vermont.

Patients
One hundred eighty-seven consecutive patients with documented blunt splenic or hepatic trauma who were admitted to a regional rural trauma referral center in Vermont during an 8-year period, beginning in January 1987, were studied. Hemodynamically stable patients underwent diagnostic imaging studies and were classified by mental status as either normal or altered. Patients who required operative intervention were excluded.

Main Outcome Measures
Morbidity and mortality rates for each group were recorded and compared to determine if statistically significant differences between the two groups existed.

Results
The groups were similar in age, systolic blood pressure, and hematocrit at admission. The group of patients with an altered mental status were more severely injured and had a longer hospital stay. Intensive care unit stays were not significantly different. Transfusion requirements for both groups were minimal; however, the group of patients with an altered mental status received more blood transfusions compared with the group of patients with a normal mental status. There was no significant difference in morbidity and mortality between the two groups. There were no failures of nonoperative management, no complications, and no missed visceral injuries in the group of patients with an altered mental status. Patients older than 50 years had higher morbidity and mortality.

Conclusions
Nonoperative management in patients with an altered mental status can be done safely in a monitored setting. This challenges the current criteria of excluding neurologically impaired patients with liver or spleen trauma from nonoperative management.

(Arch Surg. 1996;131:309-315)

Author Affiliations
From the Department of Surgery, National Naval Medical Center, Bethesda, Md (Dr Archer), and the Department of Surgery, The University of Vermont College of Medicine, Burlington (Drs Rogers and Shackford).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Beyond splenectomy -- options for the management of splenic trauma
Whitfield and Garner
Trauma 2008;10:247-259.
ABSTRACT  

Nonoperative Management of Spleen and Liver Injuries
Stein and Scalea
J Intensive Care Med 2006;21:296-304.
 

Role of Vascular and Interventional Radiology in the Diagnosis and Management of Acute Trauma Patients
Morris
J Intensive Care Med 2002;17:112-126.
ABSTRACT  

Nonsurgical Management of Blunt Splenic Injury: Use of CT Criteria to Select Patients for Splenic Arteriography and Potential Endovascular Therapy
Shanmuganathan et al.
Radiology 2000;217:75-82.
ABSTRACT | FULL TEXT  

Statewide Variation in the Treatment of Patients Hospitalized With Spleen Injury
Mangus et al.
Arch Surg 1999;134:1378-1384.
ABSTRACT | FULL TEXT  

Delayed Complications of Nonoperative Management of Blunt Adult Splenic Trauma
Cocanour et al.
Arch Surg 1998;133:619-625.
ABSTRACT | FULL TEXT