Splenic injury admitted to a rural Level 3 trauma centre: A 10-year audit

Objective There is paucity of research documenting the management of splenic injury in rural Australia. No data exists for Rural, Remote and Metropolitan Area 4 locations. Design A retrospective review of prospectively collected data. Records were additionally sought from transfer hospitals. A qualitative assessment of splenic trauma management in the Wimmera Region was also performed. Setting Wimmera Health Care Group: Horsham Campus, a Level 3 trauma hospital between January 2000 and July 2011. Participants Patients coded with injury of spleen or excision procedure on spleen. Interventions Nil Main outcome measures surgical vs. non-surgical management Results Nineteen patients were included (mean age 27.8, range 8-54). Only 26% were from Horsham. Most injuries were due to sporting trauma/falls (53%) and motor vehicle accidents (37%). One patient died in theatre from massive trauma. Eleven patients were managed non-operatively. Seven patients had splenec- tomy performed. Four of these had delay in computed tomography scanning, delay to theatre and suffered major postoperative complication. The age (mean 39.9 versus 20.8) and Injury Severity Score (mean 21.9 versus 13.8) of patients requiring splenectomy was higher than those managed non-operatively. Six of the splenic injury admissions (32%) were transferred from surrounding general practitioner-run Rural, Remote and Metropolitan Area 5 hospitals. All of these patients had Victorian State Trauma Service-defined major trauma with an Injury Severity Score >15. There was an approximate 4-hour delay in transfer of these patients, with transfer occurring when clinical deterioration occurred. Conclusions Although splenic injury is uncommon in the Wimmera region, improved trauma triaging is required, with early transfer of unstable patients and high-energy trauma mechanisms. A lower threshold for computed tomography scanning is recommended.