Any fracture to the rib cage, particularly the left sided ribs, implies a high impact trauma and higher predisposition to splenic injury. Our hypothesis is that injuries causing fractures to the left sided ribs may indicate a high-grade splenic injury which may require splenectomy. This would help the surgeon working in rural and limited resource settings, to plan splenectomy in hemodynamically stable patients with an undetermined grade of splenic injury. With this hypothesis in mind, we aimed to determine how fractures to the left sided ribs, in cases of splenic injury, are associated with splenectomy.
We performed a subgroup analysis of patients with splenic injury from a prospective trauma registry study named ‘Towards Improved Trauma Care Outcomes’ in India. Categorical variables were analyzed using the chi square test and a binary logistic regression was developed to assess the significance of continuous variables.
During the study period, a total of 16047 patients were included. Of these, 267 patients suffered from splenic injury and 70 patients required splenectomy. Fractures of the left sided ribs was not associated with splenectomy. Injury severity score (ISS), a lower systolic blood pressure and oxygen saturation at arrival, requirement of blood transfusions within 24 hours of admission and a higher grade of splenic injury (grade 4 and grade 5) were associated with splenectomy.
In contradiction to our initial hypothesis, we found that left sided rib fractures were not significantly associated with splenectomy. Grade of splenic injury was an important determinant of splenectomy.