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

Background: 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. Methods: 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). Results: 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). Conclusion: NOM of ASO injuries may attempted in adult patients with multiple injuries without increased morbidity.