66 - ANALYSIS OF NEED FOR INTERVENTION FOLLOWING LOW-GRADE TRAUMATIC SPLEEN INJURY

Objectives: This study aimed to describe the interventions required for blunt, low-grade splenic injuries required during hospitalization.

Methods: We conducted a retrospective descriptive analysis of patients admitted to a level I trauma center with AAST grade 1 (G1) and 2 (G2) splenic injuries and low injury burden (ISS < 15) between January 2017 and December 2019 using the National Trauma Registry System (TRACS). Demographic information was collected, and the electronic medical record was reviewed for clinical details. The primary outcome was any intervention (splenectomy, splenic artery embolization, or blood transfusion). Secondary outcomes included time to intervention and hospital length of stay.

Results: One hundred and seven patients met inclusion criteria, 61 (57.0%) had G1 injuries and 46 (43.0%) had G2 injuries. Median ISS was 12.0 for G1 and 9.0 for G2. Fifty-five (90.16%) of G1 and 39 (84.78%) of G2 required no intervention.

Four (4.56%) G1 patients required a median of 2 blood products while 6 (13.04%) of G2 patients required a median of 3.0 blood products. Median time to transfusion for G1 and G2 injuries were 3.19 and 9.84 hours, respectively. Of the 10 patients who received blood products, 4 (40%) had significant bleeding from other injuries, 4 (40%) received plasma only for warfarin reversal, and the remaining 2 (20%) had significant medical comorbidities.

One patient with a G1 injury and one patient with G2 injuries required splenic artery embolization with median time to intervention of 8.96 days and 17.52 hours, respectively. Notably, the one G1 patient who underwent splenic artery embolization was discharged in stable condition 2 days post-injury and then represented 8 days post-injury with new abdominal pain, while the G2 patient presented with a concurrent NSTEMI, hemoperitoneum, but no active extravasation on imaging. One patient with G1 injury and no patients with G2 injury required splenectomy. Concomitant hollow viscous injury was the primary surgical indication for the patient that underwent splenectomy.

Conclusion: Low-grade blunt splenic trauma has a low rate of intervention, typically within the first 12 hours of presentation. These results suggest that outpatient management with return precautions may be appropriate for select patients with blunt, low-grade splenic trauma and no comorbidities after a short interval of observation.