Delayed diagnosis of splenic injuries: A case series

Introduction: Injury of the spleen may result in significant morbidity and mortality, often related to blood loss. Splenic injuries may be missed on the initial Emergency Department (ED) presentation. This study was undertaken to describe cases of delayed diagnosis, and to identify factors associated with delayed diagnosis, treatment, and outcomes. Methods: This retrospective study examined eligible participants with injury to the spleen who were admitted between July 2015–December 2017. Eligible participants included patients age 16 and over with injury to the spleen, with two or more ED presentations prior to admission and inpatient management. Data collected included age, gender, ethnicity, trauma triage category, vital signs, mechanism of injury, CT diagnosis, time from injury to diagnosis, toxicologic test results, inpatient management, outcome, and days of hospitalization. Results: Among 210 patients with splenic injury, the mean age was 36. Most participants were male (N = 132; 63%) and White (N = 165; 79%). A small percentage (6%) was not diagnosed with splenic injury during the initial ED encounter. Missed diagnosis on the initial ED visit was not associated with age, gender, ethnicity, mechanism of injury, vital signs, grade of injury, intervention, or days of hospitalization. Most patients were discharged home (N = 9); a minority died (N = 1) or were discharged to a rehabilitation facility (N = 1). Conclusions: In this study, 6% of patients with splenic injury were not diagnosed during the initial ED encounter. These patients with delayed diagnosis had similar grade of injury, need for intervention, days of hospitalization, and outcome.