Adult Blunt Splenic Injury: Observation vs. Splenic Artery Embolization

Embolization is associated with lower failure rates among patients with the most severe injuries.


In hemodynamically stable children with blunt splenic injury, nonoperative management (observation, splenic artery embolization, or both) is the primary treatment modality. This is less true for adults, who have higher risk for delayed rupture after hospital discharge. To compare outcomes associated with observation versus splenic artery embolization in adults, researchers conducted a meta-analysis of 33 clinical trials involving 10,157 adult patients with blunt splenic injury between 1994 and 2009.

Overall, 68% of patients underwent nonoperative management with a failure rate (defined as need for surgery) of 8%. The failure rate with observation-only increased significantly with severity of injury from 4% for grade 1 injury to 83% for grade 5 injury, whereas the corresponding increase in failure rate with embolization from 17% to 25% was not significant. Among patients with grade 4 and grade 5 injuries, failure rates were significantly higher with observation than with embolization.


Citation(s):

Requarth JA et al. Nonoperative management of adult blunt splenic injury with and without splenic artery embolotherapy: A meta-analysis. J Trauma 2011 Oct; 71:898.