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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…