Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa



We aimed to expand on the global surgical discussion around splenic trauma in order to understand locally and clinically relevant factors for operative (OP) and non-operative management (NOM) of splenic trauma in a South African setting.


A retrospective cohort study was performed using 2013–2017 data from the Pietermaritzburg Metropolitan Trauma Service. All adult patients (≥15 years) were included. Those managed with OP or NOM for splenic trauma were identified and analyzed descriptively. Multiple logistic regression analysis identified patients and clinical factors associated with management type.


There were 127 patients with splenic injury. Median age was 29 [19–35] years with 42 (33%) women and 85 (67%) men. Blunt injuries occurred in the majority (81, 64%). Organ Injury Scale (OIS) grades included I (25, 20%), II (43, 34%), III (36, 28%), IV (15, 11%), and V (8, 6%). Nine patients expired. On univariate analysis, increasing OIS was associated with OP management, need for intensive care unit (ICU) admission, and hospital and ICU duration of stay, but not mortality. In patients with a delayed compared to early presentation, ICU utilization (62% vs. 36%, p = 0.008) and mortality (14% vs. 4%, p = 0.03) were increased. After adjusting for age, sex, presence of shock, and splenic OIS, penetrating trauma (adjusted odds ratio, 5.7; 95%CI, 1.7–9.8) and admission lactate concentration (adjusted odds ratio, 1.4; 95%CI 1.1–1.9) were significantly associated with OP compared to NOM (p = 0.002; area under the curve 0.81).


We have identified injury mechanism and admission lactate as factors predictive of OP in South African patients with splenic trauma. Timely presentation to definitive care affects both ICU duration of stay and mortality outcomes. Future global surgical efforts may focus on expanding non-operative management protocols and improving pre-hospital care in patients with splenic trauma.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA


  1. 1.

    Teuben M, Spijkerman R, Pfeifer R, Blokhuis T, Huige J, Pape H-C et al (2019) Correction to: Selective non-operative management for penetrating splenic trauma: a systematic review. Eur J Trauma Emerg Surg.

  2. 2.

    Myers JG, Dent DL, Stewart RM, Gray GA, Smith DS, Rhodes JE et al (2000) Blunt splenic injuries: dedicated trauma surgeons can achieve a high rate of nonoperative success in patients of all ages. J Trauma Inj Infect Crit Care 48(5):801–806

  3. 3.

    Dent D, Alsabrook G, Erickson BA, Myers J, Wholey M, Stewart R et al (2004) Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma Inj Infect Crit Care 56(5):1063–1067

  4. 4.

    Fodor M, Primavesi F, Morell-Hofert D, Kranebitter V, Palaver A, Braunwarth E et al (2019) Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years. World J Emerg Surg 14(1):1–12

  5. 5.

    Leppäniemi A (2019) Nonoperative management of solid abdominal organ injuries: from past to present. Scand J Surg 108(2):95–100

  6. 6.

    Meara JG, Hagander L, Leather AJM (2014) Surgery and global health: a lancet commission. Lancet 383(9911):12–13.

  7. 7.

    Dare AJ, Grimes CE, Gillies R, Greenberg SLM, Hagander L, Meara JG et al (2014) Global surgery: defining an emerging global health field. Lancet 384(9961):2245–2247

  8. 8.

    Demetriades D, Rabinowitz R (1984) Selective conservative management of abdominal gunshot wounds: a prospective study. Br J Surg 77(6):652–655

  9. 9.

    Demetriades D, Charalambides D, Lakhoo M, Pantanowitz D (1991) Gunshot wound of the abdomen: role of selective conservative management. Br J Surg 78(2):220–222

  10. 10.

    Clarke DL, Thomson SR, Madiba TE, Muckart DJJ (2005) Selective conservatism in trauma management: a South African contribution. World J Surg 29(8):962–965.

  11. 11.

    Laing GL, Bruce JL, Skinner DL, Allorto NL, Clarke DL, Aldous C (2014) Development, implementation, and evaluation of a hybrid electronic medical record system specifically designed for a developing world surgical service. World J Surg 38(6):1388–1397.

  12. 12.

    Donovan MM, Kong VY, Bruce JL, Laing GL, Bekker W, Manchev V et al (2019) The Hybrid electronic medical registry allows benchmarking of quality of trauma care: a five-year temporal overview of the trauma burden at a major trauma centre in South Africa. World J Surg 43(4):1014–1021.

  13. 13.

    Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C et al (2018) Organ injury scaling 2018 update. J Trauma Acute Care Surg. 85(6):1119–1122

  14. 14.

    Laing GL, Skinner DL, Bruce JL, Bekker W, Oosthuizen GV, Clarke DL (2014) A multi faceted quality improvement programme results in improved outcomes for the selective non-operative management of penetrating abdominal trauma in a developing world trauma centre. Injury 45(1):327–332.

  15. 15.

    Nabeel Zafar S, Rushing A, Haut ER, Kisat MT, Villegas CV, Chi A et al (2012) Outcome of selective non-operative management of penetrating abdominal injuries from the North American National Trauma Database. Br J Surg 99(Suppl 1):155–164

  16. 16.

    Clarke DL, Allorto NL, Thomson SR (2010) An audit of failed non-operative management of abdominal stab wounds. Injury 41(5):488–491.

  17. 17.

    Dayananda KSS, Kong VY, Bruce JL, Oosthuizen GV, Laing GL, Clarke DL (2017) Selective non-operative management of abdominal stab wounds is a safe and cost effective strategy: a South African experience. Ann R Coll Surg Engl 99(6):490–496

  18. 18.

    Velhamos GC, Chan LS, Kamel E, Murray JA, Yassa N, Kahaku D, Berne TV, Demetriades D (2000) Nonoperative management of splenic injuries have we gone too far? JAMA Surg 135(6):674–681

  19. 19.

    Olthof DC, Joosse P, Van Der Vlies CH, De Haan RJ, Goslings JC (2013) Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 74(2):546–557

  20. 20.

    Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE et al (2017) Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 12(1):1–26

  21. 21.

    Peitzman AB, Harbrecht BG, Rivera L, Heil B (2005) Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg 201(2):179–187

  22. 22.

    Heuer M, Taeger G, Kaiser GM, Nast-Kolb D, Kühne CA, Ruchholtz S et al (2010) No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients. Eur J Med Res 15(6):258–265

  23. 23.

    Hernandez MC, Khasawneh M, Contreras-Peraza N, Lohse C, Stephens D, Kim BD et al (2019) Vaccination and splenectomy in Olmsted County. Surgery. Available from:

  24. 24.

    Bach O, Baier M, Pullwitt A, Fosiko N, Chagaluka G, Kalima M et al (2005) Falciparum malaria after splenectomy: a prospective controlled study of 33 previously splenectomized Malawian adults. Trans R Soc Trop Med Hyg 99(11):861–867

  25. 25.

    Boone KE, Watters DAK (1995) The incidence of malaria after splenectomy in Papua New Guinea. BMJ 311(7015):1273

  26. 26.

    Lord RVN, Coleman MJ, Milliken ST (1998) Splenectomy for HIV-related immune thrombocytopenia. Arch Surg 133(2):205–210

  27. 27.

    Akpen N (2015) Role of splenectomy for immune thrombocytopenic purpura (ITP) in the era of new second-line therapies and in the setting of a high prevalence of HIV-associated ITP. South African Med J 105(5):408–412

  28. 28.

    Obekpa PO, Uqwu BT, Kidmas AT, Momoh JT, Edino S, Igun G (1997) Experience in managing splenic trauma in Jos Plateau. West Afr J Med 16(3):150–156

  29. 29.

    Bagaria D, Kumar A, Ratan A, Gupta A, Kuma A, Kumar S, Mishra B, Sagar S (2019) Changing aspects in the management of splenic injury patients: experience of 129 isolated splenic injury patients at level 1 trauma center from India. J Emerg Trauma Shock. 12(1):35–39

  30. 30.

    Trejo-Avila ME, Valenzuela-Salazar C, Betancourt-Ferreyra J, Fernandez-Enriquez E, Romero-Loera S, Moreno-Portillo M (2017) Laparoscopic versus open surgery for abdominal trauma: a case-matched study. J Laparoendosc Adv Surg Tech A 27(4):383–387

Download references

Author information

Correspondence to Damian L. Clarke.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hernandez, M.C., Traynor, M.D., Knight, A.W. et al. Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa. World J Surg (2020).

Download citation