The pattern and management outcomes of splenic injuries in the Assir region of Saudi Arabia.

BACKGROUND

In the last decade or so, the management of splenic injuries has undergone a lot of debate and changes including refinement of the indications for non-operative management (NOM). The aims of this retrospective study are: to characterize the pattern of splenic injuries in the Abha region of Saudi Arabia; to analyze the mechanisms of injury; and to review the treatment modalities employed and their outcome.

DESIGN

This is a retrospective chart review.

SETTING

Assir Central Hospital, Abha (A level II regional trauma centre).

PATIENTS: All 61 patients above the age of twelve years admitted into the hospital with splenic injuries over the nine year period from May 1994 to May 2003 formed the basis of the study.

OUTCOME MEASURES: These included complications during management and mortality. Detailed analyses of the outcome measures were carried out using the student t test, chi-square test, and means.

RESULTS

The mean age of the patients was 29.75 +/- 15.13 years. M:F ratio = 29.5:1. The splenic injury was caused predominantly by motor vehicular accidents (MVA) (52 patients--87.2%). High speed, non-use of seat belts, major vehicular deformity, car rollover and lack of air bags in the vehicles were the major characteristics of the MVA. The main clinical presenting features in the patients were related to blood loss, associated head and chest injuries. The mean duration of hospital stay was 18.8 +/- 21.31 days (Range = 1-123 days). There was no significant correlation between the haemoglobin on admission and the haemoglobin six hours after admission (Pearson correlation coefficient = 0.303, p = 0.057). The mean volume of blood transfused in the first 24 hours of admission was 1,788.75 ml +/- 842.65 (range = 250-4,000 cc). Splenectomy was performed in 58 patients (95.1%) while the remaining 3 (4.9%) were managed conservatively. The complications that had significant effect on clinical outcome, especially mortality, included bronchopneumonia (p=0.001), brain death (p=0.000), renal failure (p=0.005), cardio-respiratory arrest (p=0.000), and hypovolaemic shock (p=0.005).

CONCLUSIONS

Splenic injuries are caused predominantly by MVA and the presentation is determined by the injuries in other organs or systems. Complications that develop during treatment do impact on mortality.