Harekrishna Majhi1, Abinasha Mohapatra2, Sachin Paul James3, Ashok Kumar Nayak4
BACKGROUND
The primary objective in the management of splenic injury earlier was to achieve
early haemostasis which resulted in splenectomy as the treatment of choice. But
after recognising the role of spleen in immune and haematopoietic functions, nonoperative
management (NOM) was started. In order to practice non-operative
management safely a better way to assess the severity of splenic injury was
necessary. Eventually it became possible with the advent of computed
tomography. Along with clinical assessment, it enabled us in the selection of
appropriate patients for non-operative management. Now this modality is
considered as the gold standard for patients who are hemodynamically stable or
readily stabilisable. It decreases the duration of hospital stay and prevents postoperative
morbidity. We wanted to find out the proportion of cases and predictors
for failure of non-operative management among splenic injury patients in VIMSAR,
Burla.
METHODS
This cross-sectional study was done among 35 patients with splenic injury who
were hemodynamically stable from November 2018 to October 2020.
RESULTS
Age, sex, systolic blood pressure, diastolic blood pressure, mechanism of injury,
Glasgow Coma Score (GCS), associated injury (if hemodynamically stable) were
not found to be significant predictors in deciding the failure of non-operative
management.
CONCLUSIONS
Most important predictor for failure of non-operative management was
development of haemodynamic instability. Tachycardia, low mean arterial
pressure (MAP), drop in haemoglobin (Hb) and haematocrit were significant
parameters in our study and all these parameters ultimately point towards
hemodynamic instability.
