From the Research
For a grade 2 splenic laceration, patients typically require 2-3 days of inpatient admission for observation and monitoring, as evidenced by various studies 1, 2, 3, 4, 5. This recommendation assumes hemodynamic stability and absence of other significant injuries. During hospitalization, patients should receive:
- Regular vital sign checks (every 4-6 hours)
- Serial hemoglobin measurements (at least daily)
- Bed rest initially with gradual mobilization as tolerated Intravenous fluids should be administered to maintain adequate hydration, and pain management with medications like acetaminophen or mild opioids may be necessary. Avoid NSAIDs due to bleeding risk. Patients can be discharged when they demonstrate stable hemoglobin levels, adequate pain control with oral medications, and ability to ambulate independently. The observation period is crucial because delayed splenic rupture can occur within the first few days after injury. After discharge, patients should avoid strenuous physical activity and contact sports for approximately 6-8 weeks to allow complete healing of the spleen. Follow-up imaging is typically recommended at 6-8 weeks post-injury to confirm healing before resuming full activities, as supported by the most recent study 5.
Some key points to consider:
- The grade of laceration and agents used for embolotherapy did not impact the outcomes, as noted in 1
- Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment, as shown in 1
- Nonoperative management of blunt splenic injury can be successful, with a high salvage rate, as demonstrated in 3
- CT staging guides safe nonoperative management, and patients not suffering injury to the splenic hilum can be managed without operation, resulting in shorter hospital stays and fewer blood products used, as indicated in 4
- Hematologic changes associated with different treatment modalities for splenic trauma are important to consider, as discussed in 5