Nonoperative management of blunt XXXX : factors influencing success in age >55 years.

@entity1 @entity130
Historically poor success rates of nonoperative management of @entity130 in elderly @entity1 have led to recommendations for operative intervention in @entity1 more than 55 years of age. Recent studies are in opposition to earlier recommendations revealing equal success rates of nonoperative management of @entity130 in all age groups. A retrospective chart review was performed to assess factors related to the successful management of @entity130 in @entity1 over 55 years of age at a Level I @entity130 center. Thirty-seven @entity1 over 55 presented with blunt @entity130 during the 5-year study period. Thirteen @entity1 were taken immediately to the operating room on the basis of clinical findings and/or abdomen/pelvis CT results. Nonoperative management was attempted in 24 @entity1 on the basis of CT findings. Nonoperative management was successful in 15 @entity1 (62.5%) and failed in eight @entity1 (33.3%). @entity1 who failed nonoperative management had significantly higher American Association for the Surgery of @entity130 grade and associated pelvic free fluid. There were no deaths related to complications from failed nonoperative management. We conclude that nonoperative management of blunt @entity130 in @entity1 over 55 may be attempted. @entity1 with higher-grade injuries and pelvic free fluid are at greater risk for failure. @entity1 with these two findings must be monitored closely. The physicians caring for elderly @entity1 with high-grade @entity130 and free fluid in the pelvis must use clinical judgment regarding the need and timing of operative management.
