Assessing the Safety of Nonintensive Care Unit Admission for Select Grade III Blunt Splenic Trauma.

Introduction: Patients with grade III blunt splenic injuries (BSIs) may require splenectomy. Currently, there is practice variation for admission of these patients to an intensive care unit (ICU) or non-ICU floor. We hypothesized that select BSI patients may be admitted to non-ICU locations without increased complications, death, or need for splenectomy.

Methods: The 2017-2019 Trauma Quality Improvement Program database was queried for non-elderly adult (18-64 y-old) grade III BSIs. Patients with hypotension, heart rate >90, respiratory rate >22, abbreviated injury scale for the head/spine/thorax/upper or lower extremity >2, or with cirrhosis, stroke, myocardial infarction, or chronic obstructive pulmonary disease were excluded as these patients might otherwise warrant ICU admission. ICU admissions were compared to non-ICU admissions. Multivariable logistic regression for mortality was performed.

Results: From 1899 patients included, 1000 (52.7%) were admitted to the ICU. There was similar demographics between cohorts (all P > 0.05). There was a higher rate of colon injury in the ICU cohort (0.9% versus 0%, P = 0.004). ICU admissions had increased rates of splenectomy (4.8% versus 2.0%, P < 0.001), major complications (1.8% versus 0.6%, P = 0.013) and length of stay (4.0 versus 3.0, P < 0.001). However, there was no difference in the rate (0.3% versus 0.4%, P = 0.60) or associated risk of mortality (odds ratio 0.68, confidence interval 0.152-3.070, P = 0.62) between cohorts.

Conclusions: The rate of splenectomy, complications, and mortality was low overall and similar or better for nearly isolated grade III BSI patients admitted to non-ICU floors. This suggests there is a population of adult grade III BSI that can avoid ICU admission.