Outcomes and Predictors of Failure of Non-Operative Management in Blunt Splenic Trauma: A South African Level I Trauma Centre Experience

Abstract

Background: Non-operative management (NOM) is the standard of care for haemodynamically stable patients with blunt splenic injury; however, failure of NOM remains clinically significant, particularly in settings where adjunctive interventions such as splenic artery embolisation are not routinely utilised. This study aimed to evaluate NOM outcomes and identify predictors of failure at a South African Level I trauma centre. Methods: A retrospective cohort study of adult patients with blunt splenic injury over a 5-year period (2020–2025) was conducted. Patients were stratified according to their initial management strategy into operative and non-operative groups. Categorical variables were compared using Fisher’s exact test, and continuous variables using the Mann–Whitney U test. Multivariable logistic regression analysis was performed to identify independent predictors of NOM failure. Results: A total of 136 patients were included. Twelve patients (8.8%) underwent immediate operative management, while 124 (91.2%) were initially managed non-operatively. NOM was successful in 112 patients (90.3%), with 12 patients (9.7%) requiring delayed operative intervention. Overall mortality was 4.4% (6/136), with all deaths attributable to associated injuries rather than isolated splenic trauma. Increased admission heart rate was independently associated with NOM failure (OR 1.04 per beat increase; 95% CI 1.01–1.08; p = 0.009). Higher Injury Severity Scores and severe traumatic brain injury were more frequent in patients with NOM failure but were not independently predictive. Splenic artery embolisation was not utilised in this cohort. Conclusions: Non-operative management is safe and effective for blunt splenic injury, with high rates of splenic preservation. Admission tachycardia predicts NOM failure and may guide early clinical decision-making. These findings support the use of NOM in low- and middle-income settings where interventional radiology is not routinely available.