Management of Blunt Splenic

Trauma Protocol

Blunt Splenic Trauma

Hemodynamic status
Hypotensive
FAST exam/DPL

Normotensive
Abdominal CT
No splenic injury:

+fluid in abd/+DPL
OR: for Ex lap &
splenectomy

No fluid/ -DPL

Find alternative source of

hemodynamic instability

Splenic injury: assign grade

Treat other injuries

Hemodynamic instability

Hemodynamically stable

Other indications for

laparotomy

No other indications for

laparotomy

Grade I, II

OR: for Ex lap

& splenectomy

No other injuries
requiring ICU care

Grade III

+ ARTERIAL
EXTRAV ! !

Admit ICU w/
Hct q6hx24h
Angioembolization

Admit to floor or stepdown

w/ Hct q12h
Stable Hct
Yes: d/c after
48hrs observatn

No:
transfuse
Hct 24

OR for >2-4u transfused

& no other sources of
bleeding; +/- repeat CT

Stable Hct

Yes: transfer to
stepdown w/ Hct
q12h x48h
Stable Hct
Yes: d/c
after
72h

No:
transfuse
Hct24

No:
transfuse
Hct 24
OR for >2-4u transfused
& no other sources of
bleeding; +/- repeat CT

Splenic Injury Grading

I: Hematoma: Subcapsular, <10% surface area

Laceration: Capsular tear, <1cm parenchymal depth

II: Hematoma: Subcapsular, 1050% surface area

Intraparenchymal, <5cm diameter
1-3cm parenchymal depth which does not Involve a trabecular vessel

III: Hematoma: Subcapsular, >50% surface area or expanding

Ruptured Subcapsular or parenchymal hematoma
Intraparenchymal hematoma >5cm or expanding hematoma
Laceration: >3cm parenchymal depth or involving trabecular vessels

IV: Laceration: involving segmental or hilar vessels, producing major

devascularization (>25% of spleen)

V: Completely shattered spleen Vascular injury

Hilar vascular injury which devascularizes spleen

References

Cogbill T, Moore E, Jurkovich J, et al. Nonoperative management of

blunt splenic trauma: a multicenter experience. J Trauma 1989;
29:1312-17.

Eposito T, Gamelli R. Injury to the spleen. In: Feliciano DV, Moore

E, Mattox K. eds. Trauma. Stamford, Conn: Appleton & Lange;
1996:525-50.

Haan J, Biffl W, Knudson M, et al. Splenic embolization revisited: A

multitcenter review. J Trauma. 2003. 56:542-7.

Peitzman A, Heil B, Rivera L, et al. Blunt splenic injury in adults:

Multi-institutional study of the Eastern Association for the Surgery of
Trauma. J of Trauma 2000. 49:177-89.