Nonoperative Management of Hepatic, Splenic, and Renal Injuries in Adults with Multiple Injuries

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Abstract
Nonoperative management (NOM) of abdominal solid organ (ASO; liver, spleen, kidney) injuries from blunt trauma in adults has gained acceptance, but multisystem trauma remains a relative contraindication to NOM. We reviewed the charts of 126 adult patients who underwent NOM of an ASO injury for success of NOM, transfusions, and complications. Patients were divided into two groups: group I had isolated ASO injuries (n = 48); group II had an ASO injury and at least one additional injury with an Abbreviated Injury Score ≥ 2 (n = 78). NOM was successful 89.6% of group I and 93.6% of group II patients (p = 0.55). Group II had higher Injury Severity Scores (20.7 ± 9.8 vs. 8.3 ± 4.9 p < 0.05) and transfusion requirements (30.8% vs. 14.6%, p < 0.05) than group I. Complication rates were not different (group I, 20.8% vs. 26.9% group II, p = 0.58). NOM of ASO injuries may attempted in adult patients with multiple injuries without increased morbidity.