Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients

Marc D. Trust, Pedro G. Teixeira, Lawrence H. Brown, Sadia Ali, Ben Coopwood, Jayson D. Aydelotte, Carlos V.R. Brown

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

BACKGROUND Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. METHODS We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. RESULTS We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). CONCLUSION Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. LEVEL OF EVIDENCE Therapeutic, level IV.

Original languageEnglish (US)
Pages (from-to)123-127
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Keywords

  • Blunt splenic injury
  • geriatric trauma patients
  • nonoperative management

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Trust, M. D., Teixeira, P. G., Brown, L. H., Ali, S., Coopwood, B., Aydelotte, J. D., & Brown, C. V. R. (2018). Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients. Journal of Trauma and Acute Care Surgery, 84(1), 123-127. https://doi.org/10.1097/TA.0000000000001731