Blunt splenic injury in adults: a decision analysis comparing options for treatment.

OBJECTIVE

To evaluate factors which influence surgeons in their decision to treat blunt splenic injuries in adults by observation, splenorrhaphy or splenectomy.

DESIGN

Decision analysis.

SETTING

Army hospital, USA.

MATERIAL

56 Selected papers on the treatment of splenic trauma published between 1983 and 1993.

INTERVENTION

Variables evaluated included the incidence of transfusion, postsplenectomy sepsis, posttransfusion hepatitis, chronic active hepatitis, cirrhosis, and rebleeding.

MAIN OUTCOME MEASURES

Quality adjusted life expectancies (QALE) after each procedure.

RESULTS

QALEs when the mean incidence of each variable was used in the decision analysis were 39.68 years for observation, 39.56 years for splenorrhaphy, and 38.94 years for splenectomy. Sensitivity analysis showed that when the incidence of transfusion was controlled, splenorrhaphy was superior, and both splenorrhaphy and observation were superior to splenectomy. Once a patient had been given blood products the advantages of non-operative management were lost.

CONCLUSIONS

Only patients with minor splenic injuries who did not require blood transfusion should be treated by observation. Patients who require blood transfusion should be explored with the object of salvaging the spleen. Some patients with severe, devitalising injuries will require splenectomy despite the best attempts to salvage the organ.