Management of blunt splenic trauma: a 10-year single-center retrospective cohort study and systematic review

Aim: Describe the management of blunt splenic trauma in a 10-year period in our department and perform a systematic review of the relevant literature. Materials and methods: Retrospective analysis of registry data from patients with splenic injury from 2014 to 2024 and systematic review of the publications in PubMed, Scopus and the Cochrane Library. Results: Sixty-eight patients, 58 males and 10 females with a mean age of 42 years, were included. Sixteen were grade I, 14 grade II, 12 grade III, 6 grade IV, and 20 grade V. Forty-two patients were treated non-operatively, and 26 underwent splenectomy. Two patients failed the non-operative management (NOM) (95.2% success rate). An increasing tendency for the number of platelets was noted. A statistically significant difference on days 5 and 10 between grade II and grade V (p=0.00056 and p=0.0118, respectively) and grades III and V (p=0.01 and p=0.01) was found, with grade V platelet count peaking on day 10. In our qualitative synthesis, 17 studies were included, with 5137 patients, mostly males with a mean age of 37 years. 1189 were grade I and II, and 2916 were grade ≥3. A significant shift towards NOM has been noted (60.5%, with success rates ranging from 76% to 100%). A preference for splenic preservation over splenectomy, which may be achieved with embolization, is indicated. Clinical and laboratory evaluation should be carefully conducted when considering splenic embolization. Conclusion: A shift towards NOM is noticed with surgical intervention restricted for hemodynamically unstable patients. Splenic embolization is an effective alternative which may be used to further establish non-surgical management.