T. Easterday1, C. Lounsbury1, S. Byerly1, D. M. Filiberto1, E. K. Lenart1, I. Howley1, P. E. Fischer1, C. Evans1, A. J. Kerwin1 1University of Tennessee Health Science Center, Trauma & Surgical Critical Care/ Department Of Surgery, Memphis, TN, USA
Introduction: Patients with blunt splenic injuries (BSI) who have nonoperative management (NOM) have serial monitoring of hemoglobin (HGB) for 24-48 hours to assess the need for intervention. Our hypothesis is serial HGB monitoring does not significantly impact decision-making in NOM of BSI.
Methods: We performed a retrospective review of adult patients admitted with BSI between 2017-2020. We excluded patients with hemodynamic instability requiring emergent splenectomy, urgent embolization for a pseudoaneurysm on initial CT, interfacility transfers and those missing data. We recorded routine demographics, admission HGB, serial HGB levels for the first 48 hours and the need for delayed splenectomy, angiography or angioembolization.
Results: We admitted 852 patients with BSI from 2017-2020 and reviewed 371 who met inclusion criteria. 13 patients required emergency splenectomy and 40 required urgent angiography to evaluate for a pseudoaneurysm leaving 318 patients who underwent NOM. Patients were divided into 2 groups [intervention (INT) and no intervention (NO INT)] based on the need for intervention. The NO INT group had 277 patients who had successful NOM (87.1%). In the INT group there were 41 patients (12.9%) who had an intervention (8 splenectomy, 21 embolization, 12 angiography only). The INT group was significantly older (45.4 vs 38 years; p < 0.0001) and had higher ISS (20.9 vs 19.3; p < 0.0001). The INT group had a higher admit HGB (13.4 vs 12.9; p < 0.0001) and higher mean number of HGB draws (6.8 vs 5.8; p < 0.0001; 95% CI 6.3 – 7.20). Primary reasons for intervention are shown in the table. Only 2 patients required an intervention based solely on a decrease in serial HGB levels.
Conclusion: Monitoring serial HGB adds little to NOM of BSI. Decisions for intervention should be based on physical exam, vital signs and selective repeat CT findings when clinically indicated.
