McIntyre et al identified a number of risk factors for failure of nonoperative management of splenic traumatic injuries. These can help to identify patients who may benefit from more aggressive management. The authors are from the University of Washington and Harborview Injury Prevention Research Center in Seattle.


Patient selection: splenic trauma undergoing nonoperative management


Risk factors associated with failure of nonoperative management:

(1) age > 55 years

(2) Injury Severity Score (ISS) > 25

(3) admission to a level III or IV trauma center



• These patients were usually not admitted to a Level V center.


Operative management may take the form of:

(1) splnectomy

(2) splenorrhaphy

(3) splenic embolization


The time to operative management ranged from 3 to 10+ days. This means that:

(1) a patient with risk factors may need to be kept under observation longer

(2) a patient discharged home needs to be informed of the risk and to be able to return if there is deterioration


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