Management of blunt splenic trauma in patients older than 55 years

Background: Many experts have suggested that blunt splenic trauma in patients older than 55 years should not be managed by observation because of supposed increased fragility of the spleen and decreased physiologic reserve in elderly patients. We sought to determine the outcome of nonoperative management of blunt splenic trauma in patients older than 55 years. Methods: For the years 1994 through 1996, data for patients with splenic injury older than 55 years from seven trauma centers in a single state were reviewed. Results: Blunt splenic trauma occurred in 41 patients older than 55 years. Eight patients were excluded from further analysis because of death from massive associated injuries within 24 hours of admission, The remaining 33 patients (mean age, 72 +/- 10 years) were divided into two groups: immediate exploration (10 patients) and observation (23 patients), Observation of blunt splenic injury failed in 4 of 23 patients (17%). No patient deaths were related to the method of management of the splenic injury. Conclusions: Observation of the elderly patient with blunt splenic trauma has an acceptable failure rate of 17%.