Assessing the Safety of Nonintensive Care Unit Admission for Select Grade III Blunt Splenic Trauma

Introduction

Patients with grade III blunt splenic injuries (BSIs) may require splenectomy. Currently, there is practice variation for admission of these patients to an intensive care unit (ICU) or non-ICU floor. We hypothesized that select BSI patients may be admitted to non-ICU locations without increased complications, death, or need for splenectomy.

Methods

The 2017-2019 Trauma Quality Improvement Program database was queried for non-elderly adult (18-64 y-old) grade III BSIs. Patients with hypotension, heart rate >90, respiratory rate >22, abbreviated injury scale for the head/spine/thorax/upper or lower extremity >2, or with cirrhosis, stroke, myocardial infarction, or chronic obstructive pulmonary disease were excluded as these patients might otherwise warrant ICU admission. ICU admissions were compared to non-ICU admissions. Multivariable logistic regression for mortality was performed.

Results

From 1899 patients included, 1000 (52.7%) were admitted to the ICU. There was similar demographics between cohorts (all P > 0.05). There was a higher rate of colon injury in the ICU cohort (0.9% versus 0%, P = 0.004). ICU admissions had increased rates of splenectomy (4.8% versus 2.0%, P < 0.001), major complications (1.8% versus 0.6%, P = 0.013) and length of stay (4.0 versus 3.0, P < 0.001). However, there was no difference in the rate (0.3% versus 0.4%, P = 0.60) or associated risk of mortality (odds ratio 0.68, confidence interval 0.152-3.070, P = 0.62) between cohorts.

Conclusions

The rate of splenectomy, complications, and mortality was low overall and similar or better for nearly isolated grade III BSI patients admitted to non-ICU floors. This suggests there is a population of adult grade III BSI that can avoid ICU admission.