Splenic Injury From Bike Accident?
An 18-year-old male sustained a splenic injury after falling from a push bike. The abdominal computed tomography (CT) scan revealed a splenic capsular laceration (Buntain Grade 1). How should patients with "minor" splenic injuries be managed? When should transfusions be considered? How long should patients stay in hospital? When should patients return to full physical activity and how should they be followed up?
Alex Hewitt, MBBS
At 18 years of age, the patient should be treated as an adult. There is a poor relationship between the anatomic grading and the degree of bleeding. If there was a blush on the CT scan from the intravenous contrast dye, surgery would be indicated. Most Grade 1 injuries can be managed nonoperatively. The trigger point for transfusion in a healthy 18-year-old would be a hematocrit of 23. If the patient is reliable, he could be discharged after serial hematocrits demonstrate no ongoing bleeding (ie, no further decrease after 2 successive hematocrits). We lack hard data as to when a person should return to full activity. If he had an intraparenchymal hematoma, the most likely time for rupture and further bleeding would be at 7-10 days postinjury. Most patients can return to full physical activity at 1 month unless they have had an intraparenchymal hematoma. These patients probably should undergo frequent ultrasound evaluation to monitor for resolution of the hematoma.
An 18-year-old male sustained a splenic injury after falling from a push bike. The abdominal computed tomography (CT) scan revealed a splenic capsular laceration (Buntain Grade 1). How should patients with "minor" splenic injuries be managed? When should transfusions be considered? How long should patients stay in hospital? When should patients return to full physical activity and how should they be followed up?
Alex Hewitt, MBBS
At 18 years of age, the patient should be treated as an adult. There is a poor relationship between the anatomic grading and the degree of bleeding. If there was a blush on the CT scan from the intravenous contrast dye, surgery would be indicated. Most Grade 1 injuries can be managed nonoperatively. The trigger point for transfusion in a healthy 18-year-old would be a hematocrit of 23. If the patient is reliable, he could be discharged after serial hematocrits demonstrate no ongoing bleeding (ie, no further decrease after 2 successive hematocrits). We lack hard data as to when a person should return to full activity. If he had an intraparenchymal hematoma, the most likely time for rupture and further bleeding would be at 7-10 days postinjury. Most patients can return to full physical activity at 1 month unless they have had an intraparenchymal hematoma. These patients probably should undergo frequent ultrasound evaluation to monitor for resolution of the hematoma.
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