Cook et al identified predictors for splenectomy in patients with cirrhosis and blunt splenic injury (BSI). These can help to identify a patient who may require more aggressive management of the splenic injury. The authors are from Oregon Health and Science University, Harborview Medical Center in Seattle, and Emanuel Medical Center in Portland.

Patient selection: cirrhosis and blunt splenic injury (BSI)


Outcome: splenectomy



(1) grade of splenic injury (from 1 to 5)

(2) admission MELD score


The risk of splenectomy and mortality is increased in a patient with cirrhosis.


Risk factors for splenectomy and/or mortality:

(1) high splenic injury grade (grade 4 and 5 injuries would be most significant, grade 3 probably significant and grade 2 possibly significant)

(2) higher MELD score (mortality was 100% for MELD >= 19; in the modified MELD score a score 10-19 had a significant increase in mortality versus a score <= 9)


A patient with cirrhosis and blunt splenic trauma requires closer monitoring and more aggressive management to avoid severe complications.

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