The Efficacy of the World Society of Emergency Surgery Classification in the Management of Splenic Injury: A Validation Study

Abstract

BACKGROUND: Due to increased recognition of the immunological role of the spleen and the long-term complications that follow splenectomy, nonoperative management (NOM) has come to the forefront in the management of splenic injuries in hemodynamically stable patients. The World Society of Emergency Surgery (WSES) classification of splenic injury represents a holistic algorithm that enables standardized care and is hence recommended across all high-volume trauma centers. MATERIALS AND METHODS: A prospective single-center observational study was carried out in the busiest trauma center of South India between December 2021 and December 2022, with the shortlisting of 65 candidates who satisfied the inclusion criteria. They were stratified in accordance with the WSES classification and managed, and outcomes were quantified. RESULTS: During the 12-month study period, 65 patients were included in the study. Among the study population, 84.6% of them were planned to have NOM and 15.4% of them had operative management at the emergency department (ED) (P = 0.042). The definitive treatment was a success in 92.3% of the patients, and it was a failure in 7.7% of the patients. The association between the plan at ED and variables such as gender, mechanism of injury, age, the American Association for the Surgery of Trauma score, and WSES staging, was statistically significant. CONCLUSION: As per our inferences, the WSES category IV is the solitary criterion relevant to immediate operative management, thus showing that the physiological status of the patient is the only variable that dictates need for an emergency laparotomy. Hence, it can be inferred that the WSES classification can be popularized as a standard of care.