Guidelines for Evaluation of a Patient with Blunt Splenic Injury

 

Initial evaluation - Is the patient hypotensive (systolic blood pressure < 90 mm Hg) or tachycardic (heart rate > 112 beats per minute)?

 

If either of these findings is present, then perform a laparotomy if one or more of the following findings is present:

(1) physical examination (left sided lower rib fractures, left upper quadrant tenderness, referred pain to left shoulder)

(2) positive diagnostic peritoneal lavage (DPL) or

(3) positive FAST (focused abdominal sonography for trauma)

If these tests are negative, then search for other causes of hypotension or tachycardia.

 

If neither finding is present, then perform CT of the abdomen and pelvis.

Splenic Injury on CT	Hemoperitoneum	Management
Grade 5		laparotomy
Grades 3 or 4	moderate or large	laparotomy
	none or small	observe
Grade 1 or 2	large	consider laparotomy
	none, small or moderate	observe
none		treat other injuries