Impact of Treatment Modality of Blunt Splenic Injuries on Discharge Status at a Level 1 Trauma Center

Management of blunt splenic trauma has evolved over several decades, trending toward nonoperative management (NOM) and splenic artery embolization (SAE). Open splenectomy can be associated with higher morbidity and need for further care after initial hospitalization. The aim of this study was to determine the effect of treatment modality of blunt splenic injuries on discharge disposition after blunt splenic trauma at a Level 1 trauma center. This is an observational retrospective study using the trauma registry and included patients with blunt splenic trauma age >18 years between July 1, 2010 and June 30, 2020. Patients included in the study were divided into three groups by treatment modality: NOM, SAE, and splenectomy. The primary outcome of unfavorable discharge was defined as discharge to long-term acute care facility, skilled nursing facility, or inpatient rehab. Baseline patient characteristics and outcome end points were examined. Patients with penetrating splenic injuries, no imaging, left against medical advice, or deceased prior to discharge were excluded. The registry provided 536 patients. Independent t-test, χ2, and binary logistic regression analyses were conducted. Statistical significance was reported at P < .05. After exclusions, 513 patients were included in the analysis. Risk factors for patients requiring unfavorable discharge were age ≥55 years (48.8% vs 24.0%; P < .01), injury severity score (ISS) >15 (88.4% vs 55.6%; P < .01), cirrhosis (6.6% vs 2.0%; P = .01), diabetes (22.3% vs 10.2%; P < .01), and cardiovascular disease (45.5% vs 29.8%; P < .01). Additionally, a higher proportion of patients with unfavorable discharge had higher intensive care unit incidence (94.2% vs 84.4%; P < .01), higher rates of health care-associated pneumonia (HCAP) (28.9% vs 6.4%; P < .01), sepsis (7.4% vs 2.0%; P < .01), and venous thromboembolism (11.6% vs 3.3%; P < .01). Of the treatment modality, patients who underwent splenectomy (41.3% vs 24.0%; P < .01) were more likely to have unfavorable discharge than those who underwent NOM or SAE. Finally, a logistic regression was conducted with all significant risk factors identified on univariate analysis. ISS >15 was the strongest predictor for unfavorable discharge (odds ratio [OR], 7.08; 95% confidence interval [CI], 3.65-13.71; P < .01) followed by HCAP (OR, 4.57; 95% CI, 2.40-8.68; P < .01) and age ≥55 years (OR, 2.98; 95% CI, 1.74-5.11; P < .01). The type of treatment modality (NOM, SAE, or splenectomy) does not affect patient discharge disposition. The greatest predictor of whether patients will have unfavorable discharge is ISS >15, development of HCAP, and age >55 years. Further data analysis is required to formalize a protocol for the management of blunt splenic trauma.