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NESS 2006 Annual Meeting
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Should the Possibility of Late Failure Prevent Early Discharge After Non-Operative Management for Splenic Injuries?
Robert S Crawford, Malek Tabbara, Robert Sheridan, Konstantinos Spaniolas, George Velmahos
Massachusetts General Hospital, Boston, MA

Objective:
(1) Compare patients with early (EF) and late failure (LF) of non-operative management of splenic injuries (NOMSI).
(2) Explore if early discharge after NOMSI should be avoided due to the possibility of LF and its related morbidity.
Design: Retrospective study.
Setting: Academic Level-one Trauma Center.
Patients: Of 691 adult trauma patients with splenic injuries (Jan. 1993 - Dec. 2005), 603(87%) survived to discharge. Of them, 499(72%) had NOMSI and 386 were discharged within 3 days. NOMSI failure was defined as the need for operation after 6 hours from admission; failure within 3 days was considered EF and after that LF.
Main Outcome Measures: Patient characteristics, injury severity, blood transfusions, mortality, length of hospital stay.
Results: Of 39 NOMSI failures (8% of all NOMSI patients), 26(67%) were EF and 13(33%) LF. The interval from admission to OR was 0.9+0.7 days for EF patients and 8.4+5.5 days for LF (4-8 days in 9 patients and 11-22 days in the remaining 4). All patients but 1 were still in the hospital for other reasons when LF occurred. No patient died, had delayed diagnosis, or suffered morbidity due to LF. None of the 386 patients who were discharged within 3 days required re-admission for LF. Results are presented in Table 1.
Table 1
Age> 65 years Grade of Splenic Injury on CT Injury Severity Score Preoperative Blood Transfusion > 2 units Hospital Stay after operation
EF (n=26) 11 (42%) 3.81 29 12 8 (32%) 2022
LF (n=13) 2 (15%) 3.11 25 514 5 (38.5%) 1623
p-value 0.01 0.11 0.41 0.16 0.63

Conclusion: Except for age, EF and LF patients are similar. LF usually occurs in patients with prolonged hospital stay due to other factors. Therefore, early discharge of NOMSI patients who do not have other significant injuries requiring hospital stay is acceptable.


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