Proportion of Cases Managed Non-Operatively and Its Predictors for Failure in Splenic Injury – A Cross Sectional Study from VSSIMSAR, Odisha

BACKGROUND The primary objective in the management of splenic injury earlier was to achieve early haemostasis which resulted in splenectomy as the treatment of choice. But after recognising the role of spleen in immune and haematopoietic functions, nonoperative management (NOM) was started. In order to practice non-operative management safely a better way to assess the severity of splenic injury was necessary. Eventually it became possible with the advent of computed tomography. Along with clinical assessment, it enabled us in the selection of appropriate patients for non-operative management. Now this modality is considered as the gold standard for patients who are hemodynamically stable or readily stabilisable. It decreases the duration of hospital stay and prevents postoperative morbidity. We wanted to find out the proportion of cases and predictors for failure of non-operative management among splenic injury patients in VIMSAR, Burla. METHODS This cross-sectional study was done among 35 patients with splenic injury who were hemodynamically stable from November 2018 to October 2020. RESULTS Age, sex, systolic blood pressure, diastolic blood pressure, mechanism of injury, Glasgow Coma Score (GCS), associated injury (if hemodynamically stable) were not found to be significant predictors in deciding the failure of non-operative management. CONCLUSIONS Most important predictor for failure of non-operative management was development of haemodynamic instability. Tachycardia, low mean arterial pressure (MAP), drop in haemoglobin (Hb) and haematocrit were significant parameters in our study and all these parameters ultimately point towards hemodynamic instability. KEYWORDS Non-Operative Management (Successful), Non-Operative Management (Failure), Hemodynamically Stable, Blunt Trauma Abdomen