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Traditional Criteria for Observation of Splenic Trauma Should Be Challenged
The American Surgeon
  • W. Trevor Gaunt, Wright State University
  • Mary C. McCarthy, Wright State University
  • Carie S. Lambert, Wright State University
  • Gary Anderson, Wright State University
  • Linda M. Barney, Wright State University
  • Margaret Dunn, Wright State University - Main Campus
  • Gary W. Lemmon, Wright State University
  • Doug B. Paul, Wright State University
  • James B. Peoples, Wright State University
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Age less than 55 years, normal Glasgow Coma Score (GCS), and absence of hypotension are traditional criteria for the selection of adult patients with blunt splenic trauma for observation. The objective of this study is to challenge these criteria. Two hundred twelve patients who presented with blunt splenic injury between 1992 and 1997 were identified from the Trauma Registry at our Level I trauma center. The patients were divided into three groups: 100 patients (47%) were observed, 108 (51%) underwent immediate splenorrhaphy or splenectomy, and 4 (2%) failed observation. The three groups were compared by participants' ages, GCSs, and histories of hypotension. No statistical differences were noted between the successfully observed patients and those requiring immediate surgery with respect to these criteria. Of the 4 patients who failed observation, all were younger than 55 years, all had a GCS >12, and all were normotensive. Our findings suggest that traditional criteria used to select patients for splenic trauma observation are not absolute indicators and should be liberalized: patients can be successfully observed despite having criteria that, in the past, would have led to immediate operative intervention.

This paper was presented at the Midwest Surgical Association Meeting, Mackinac Island, MI, August 16-18, 1998.

Citation Information
W. Trevor Gaunt, Mary C. McCarthy, Carie S. Lambert, Gary Anderson, et al.. "Traditional Criteria for Observation of Splenic Trauma Should Be Challenged" The American Surgeon Vol. 65 Iss. 7 (1999) p. 689 - 691 ISSN: 00031348
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