Risk factors for failures of non-operative management in adults with blunt splenic injury

NING Chen; ZHU Dong-bo; GONG Hui; WANG Jian; CUI Shi-tao; SHI Shen-ping

Abstract：Objective To explore the causes and risk factors of non-operative management ( NOM) fail-ure in adults with blunt splenic injury.Methods A total of 110 adults cases admitted from Nov.2011 to Mar.2014 with blunt splenic injury ( BSI) were reviewed retrospectively,among whom 58 patients received NOM initially.A-mong these patients,36 were male and 22 were female.The average age was (43.4 ±15.1) years(17-89 years). The patients were then divided into success group and failure group based on whether they were performed laparoto-my.Univariate and multivariate logistic analyses were performed to investigate correlative factors affecting the out-come of NOM in adults with BSI and to identify independent risk factors of NOM failure.Results The rate of NOM was 52.7%(58/110).The rate of NOM failure was 24.14%(14/58) and no death occurred.The main causes of failure were active bleeding,early rebleeding and incorrect classification of splenic injuries in the early stage and de-layed subcapsular hematoma in the late stage.Univariate analysis revealed that factors associated with NOM failure in patients with BSI were shock index, degree of hemoperitoneum, grade of splenic injury, injury severity score ( ISS) ,new injury severity score( NISS) ,amount of transfused RBCs as well as hospitalization period( length of hos-pital stay),(P<0.05).Multivariate logistic regression analysis showed that the presence of moderate or large hae-moperitoneum,higher-grade splenic injury(AAST grade 3-5)and transfusion of more than 4U of RBCs were inde-pendent predictors of NOM failure.Conclusion Moderate or large haemoperitoneum,higher-grade splenic injury and transfusion of more than 4U of RBCs are high risk factors for NOM failure in adults with blunt splenic injury.