Splenic injury - Forum

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Splenic injury - Ärzteforum

Post#1 »

Tonight I was asked to see a 73 year-old woman, smoker with no
past history who presented after a fall on a staircase with LUQ pain.
She came to the ER in the morning of the 18th but was discharged with no
further investigation. Came back today (36 hours post injury) with
worsening pain, CT shows
grade IV-V splenic injury, no pooling of contrast, Hb 94, pulse 96, BP

Does anyone still use age more than 55 as criteria for operative
management? What about routine angio-embolization of grade V injuries?
What would be your management? What wou

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Old surgeon

Re: Splenic injury - Ärzteforum

Post#2 »

Question 1. No--data now exists to refute this
2, No--but is an option for stable patient with persistently falling Hgb/Hct
3. Observe--after 3 days, it's all been done for you anyway
4. No different--and obviously it would have worked

John Dissector

Re: Splenic injury - Ärzteforum

Post#3 »

I agree that there is no data.
It would be probably more appropriate to say that the indication for a
discharge is along with stable hemodynamics and Hct, a patient performance
i.e. tolerance to physical activities and diet. I don't remember any of the
patients I observed who met these criteria on post-injury day 3 or 4
(except for children).
I think a vaccination is a good idea too.
As far as paying for what we are doing, you are right again. Here in KY, we
do pay an extremely high primium for our health insurance because majority
of people are non-insured. And when we do something like this, based solely
on our impression and experience but not on solid evidence we do wast
money (including our own)


Re: Splenic injury - Ärzteforum

Post#4 »

The internal medicine literature recommends pneumococcal, meningococcal and
hemophilus influenza immunizations, but as you say, this is probably based more
on medical reasons for splenectomy.


Re: Splenic injury - Ärzteforum

Post#5 »

I understand that the vaccine is based on strains of pneumococci prevalent in the US. Such vaccines are of less use to the rest of the world.

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Re: Splenic injury - Ärzteforum

Post#6 »

Though I do not have an immediate answer to your question, I follow the
recommendations of CDC. Those are recommendations about vaccination and
revaccination against pneumococci.

The recommendation is class A which they define as follows: A=Strong
epidemiologic evidence and substantial clinical benefit support the
recommendation for vaccine use.

Persons aged 2-64 years with functional or anatomic asplenia:
If patient is aged >10 years: single
revaccination >=5 years after previous dose.
If patient is aged <=10 years years: consider revaccination 3 years after
previous dose.

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