Journal of Emergencies, Trauma, and Shock
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
Users online:2555   Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size   

 Table of Contents    
Year : 2020  |  Volume : 13  |  Issue : 4  |  Page : 319-320
Predictors of failure of nonoperative management in spleen trauma

Department of General Surgery, Traumatology and Severe Burns Center, Ben Arous, University of Tunis El Manar, Tunis, Tunisia

Click here for correspondence address and email

Date of Submission06-May-2020
Date of Acceptance25-May-2020
Date of Web Publication7-Dec-2020

How to cite this article:
Zenaidi H, Ismail IB, Rebii S, Zoghlami A. Predictors of failure of nonoperative management in spleen trauma. J Emerg Trauma Shock 2020;13:319-20

How to cite this URL:
Zenaidi H, Ismail IB, Rebii S, Zoghlami A. Predictors of failure of nonoperative management in spleen trauma. J Emerg Trauma Shock [serial online] 2020 [cited 2022 Sep 26];13:319-20. Available from:


The standard treatment of choice for hemodynamically stable patients with blunt splenic trauma is currently, nonoperative management (NOM), thanks to the development in intensive care units and the improvement of computed tomography and angioembolization technique.[1] However, the indications and criteria for successful (NOM) remain controversial. The study is aimed to evaluate the feasibility of conservative treatment and to identify the main predictor factors of NOM to choose the most appropriate therapeutic attitude.

A retrospective multivariate regression analysis was carried out of 100 patients with injury to the spleen between 2013 and 2018. A total of 100 patients were identified (80 men and 20 women) with a median age of 36 ± 15.75 years. In 59 cases, spleen lesions were associated with other intra-abdominal involvement mainly in the liver (57.6%) and kidneys (50.8%). Nine patients were admitted for penetrating splenic trauma, among which three had an attempt of NOM, which was successful in two-thirds of the cases. Ninety-one patients were admitted for blunt splenic trauma with an attempt of NOM in 81.3% of cases and a success rate of 86.5%. Our analytical study [Table 1] found that predictors of NOM failure were age ≥55 years (P = 0.011), SBP at admission <100 mmHg (P = 0.000071), or shock on admission (P = 0.028), a transfusion of three units or more of packed red cells (PRC) (P = 0.0029), as well as associated pancreatic injury (P = 0.00018) or intra-abdominal hollow organ injury (P = 0.01). As a result of the multivariate logistic regression analysis [Table 2], SBP <100 mmHg (odds ratio [OR] = 1.293; 95% confidence interval [CI] = 1.045–1.601; P = 0.018) and blood transfusion >3 PRC (OR = 2.739; 95% CI = 1.140–6.581; P = 0.024) were determined to be independent predictive factors for the failure of NOM.
Table 1: Univariate analysis of patient and trauma characteristics

Click here to view
Table 2: Results of the multivariate logistic regression analysis

Click here to view

NOM means surgical observation with a serial physical examination, serial computed tomography, or angiographic embolization. The overall success rate reported in the literature ranged from 78% to 98%.[2] In our study, the success rate was 86.5%. Several studies determined a correlation between failed NOM and statistically significantly lower SBP in admission.[3],[4] and higher requirement in blood transfusion in the first 24 h.[5] Special attention should be paid to these patients when they are treated with NOM approaches.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Dembele BT, Kante L, Traore A, Togo A, Diakite I, Camara M, et al. Traumatismes de la rate dans le service de chirurgie générale du CHU Gabriel Touré. J Afr Hépatol Gastroentérol 2014;8:152-5.  Back to cited text no. 1
Watson GA, Rosengart MR, Zenati MS, Tsung A, Forsythe RM, Peitzman AB, et al. Nonoperative management of severe blunt splenic injury: Are we getting better? Aust N Z J Surg 2006;61:1113-9.  Back to cited text no. 2
Gonzalez M, Bucher P, Ris F, Andereggen E, Morel P. Splenic trauma: Predictive factors for failure of non-operative management. J Chir (Paris) 2008;145:561-7.  Back to cited text no. 3
Bhangu A, Nepogodiev D, Lal N, Bowley DM. Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma. Injury 2012;43:1337-46.  Back to cited text no. 4
Maull KI. Current status of nonoperative management of liver injuries. World J Surg 2001;25:1403-4.  Back to cited text no. 5

Correspondence Address:
Imen Ben Ismail
Rue Du 1er Mai Cité El Iskan 2013 Ben Arous, Ben Arous
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JETS.JETS_60_20

Rights and Permissions


  [Table 1], [Table 2]

This article has been cited by
1 Development and Validation of a Nomogram for Adverse Outcomes of Geriatric Trauma Patients Based on Frailty Syndrome
Yangfan Zhuang, Hao Tu, Quanrui Feng, Huiming Tang, Li Fu, Yuchang Wang, Xiangjun Bai
International Journal of General Medicine. 2022; Volume 15: 5499
[Pubmed] | [DOI]
2 Non-operative management in blunt splenic trauma: A ten-years-experience at a Level 1 Trauma Center
Serena Musetti, Federico Coccolini, Dario Tartaglia, Camilla Cremonini, Silvia Strambi, Enrico Cicuttin, Luigi Cobuccio, Ismail Cengeli, Giuseppe Zocco, Massimo Chiarugi
Emergency Care Journal. 2022; 18(1)
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Tables

 Article Access Statistics
    PDF Downloaded41    
    Comments [Add]    
    Cited by others 2    

Recommend this journal