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: BackgroundThe factors important in determining outcome when managing adult blunt splenic injuries continue to be debated. Whether trauma center level designation (Level I versus Level II) affects patient management has not been evaluated.: Study designWe conducted a retrospective analysis of prospectively gathered data from the Pennsylvania Trauma Outcome Study database that collected information from 27 statewide trauma centers (Level I [15], Level II [17]). Adult patients (ages ≥ 16 years) with blunt splenic injuries (ICD-9-CM 865) were evaluated. Demographic data, injury data, and trauma center level designation were collected, and patient management, length of stay, and mortality were analyzed.: ResultsThere were 2,138 adult patients who suffered blunt splenic injuries during the study period (1998–2000). Patients treated at Level II trauma centers (n = 772) had a higher rate of operative treatment (38.2% versus 30.7%) (p < 0.001), but a shorter mean length of stay (10.1 ± 0.4 versus 12.0 ± 0.4 days) (p < 0.01) compared with patients in Level I trauma centers (n = 1,366). The rate of failure of nonoperative treatment was lower at Level II trauma centers (13.0% versus 17.6%) (p < 0.05), but the mortality for patients managed nonoperatively was higher (8.4% versus 4.5%) (p < 0.05). Splenorrhaphy was performed more frequently in Level I trauma centers.: ConclusionsManagement differences exist in the treatment of adult blunt splenic injuries between institutions of different trauma center level designation. Multicenter studies should account for this finding in design and implementation. [Copyright &y& Elsevier]

Background: Nonoperative management has become the standard for >80% of the blunt liver injuries. In the cases where operation is required, current operative management emphasizes packing, damage control, and early utilization of interventional radiology for angiography and embolization. Liver resection is thought to have minimal role in the management of hepatic injury because of the high morbidity and mortality in many reports. The objective of this study was to show that the management of complex liver injuries with anatomic or nonanatomic resection can be accomplished by experienced trauma surgeons, in conjunction with liver surgeons in some cases, with low morbidity and mortality related to the procedure. Delayed, planned anatomic resection was also applied., Methods: This is a retrospective, observational study, on patients admitted to the University of Pittsburgh Medical Center (UPMC)-Presbyterian from December 1986 through March 2001. The patients included in this report underwent hepatic resection for complex liver injuries (grade 3, 4, and 5) according to the American for Association the Surgery of Trauma-Organ Injury Scale. Age, sex, mechanism of trauma, type of resection (nonanatomic, segmentectomy, lobectomy, and hepatectomy), surgical complications, hospital length of stay, and mortality were the variables analyzed., Results: Two hundred sixteen adult patients were admitted with complex liver injury, during the period of December 1986 to March 2001. Fifty-six patients of this series underwent liver resection: 21 anatomic segmentectomies, 23 nonanatomic resections, 3 left lobectomies, 8 right lobectomies, and 1 hepatectomy with orthotopic liver transplant. The median age was 31 years (range, 15-83 years). The Injury severity Score average was 34 +/- 10 (range, 16-59). Mechanism was blunt in 62.5% and penetrating in 37.5%. The grades of hepatic injury were 9 grade III, 32 grade IV, and 15 grade V. A total of 28.5% (16 of 56) of patients had concomitant hepatic venous injury. The overall morbidity was 62.5%. The morbidity related to liver resection was 30%. The overall mortality of the series was 17.8%. Mortality from liver injury was 9% in this series of patients undergoing liver resection for complex hepatic injury., Conclusions: This study demonstrates that liver resection should be considered as a surgical option in patients with complex injury, as initial or delayed management, and can be accomplished with low mortality and liver related morbidity.

Background: The management of splenic injuries has evolved with a greater emphasis on nonoperative management. Although several institutions have demonstrated that nonoperative management of splenic injuries can be performed with an increasing degree of success, the impact of this treatment shift on outcome for all patients with splenic injuries remains unknown. We hypothesized that outcomes for patients with splenic injuries have improved as the paradigm for splenic injury treatment has shifted., Methods: Consecutive patients from 1987 to 2001 with splenic injuries who were entered into a state trauma registry were reviewed. Demographic variables, injury characteristics, and outcome data were collected., Results: The number of patients who were diagnosed with splenic injuries increased from 1987 through 2001, despite a stable number of institutions submitting data to the registry. The number of minor injuries and severe splenic injuries remained stable, and the number of moderately severe injuries significantly increased over time. Overall mortality rate improved but primarily reflected the decreased mortality rates of moderately severe injuries; the mortality rate for severe splenic injuries was unchanged., Conclusion: Trauma centers are seeing increasing numbers of splenic injuries that are less severe in magnitude, although the number of the most severe splenic injuries is stable. The increased proportion of patients with less severe splenic injuries who are being admitted to trauma centers is a significant factor in the increased use and success rate of nonoperative management.