OSCE — Splenic Injury and Splenectomy · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Splenic Injury and Splenectomy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

The spleen is the most commonly injured solid organ in blunt abdominal trauma. The AAST grading system (Grade I–V; 2018 vascular modifiers) stratifies anatomy, but physiology decides treatment. EAST: non-operative management is the treatment of choice in haemodynamically stable patients irrespective of grade, age, or associated injuries, provided monitoring and an operating room are immediately available. Requarth: 68.4% of more than 10,000 adults were managed non-operatively with an overall NOM failure of 8.3%. Splenectomy is reserved for haemodynamic instability, peritonitis, or failed NOM. The critical post-operative concern is overwhelming post-splenectomy infection (OPSI) — WSES incidence 0.5–2% and mortality 30–70%; Davidson lifetime risk 5% and mortality 38–69%, with pneumococcus 50–90% of blood-culture isolates. Prevention: PCV13 then PPSV23 at least 8 weeks later, meningococcal/Hib cover, annual influenza, standby amoxycillin, and patient education.

Candidate tasks

Clarify onset, severity, associated features, and red-flag symptoms.
State focused examination priorities.
List first-line investigations and any named score/criteria.
Give immediate resuscitation steps.
Outline definitive management with doses/routes where standard.
Name complications and disposition (ward / HDU / theatre / discharge safety-net).
Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Domain	Pass behaviours
Definition	Correct working diagnosis language
Assessment	Focused, prioritised, red flags sought
Investigations	Appropriate first-line + interpretation
Emergency care	ABC / time-critical actions first
Definitive care	Specific drugs/procedures, not generic phrases
Safety	Haemodynamic instability after blunt abdominal trauma = urgent laparotomy — do not delay for CT
Safety	Kehr's sign (left shoulder pain) with hypotension = splenic rupture until proven otherwise
Safety	Any fever in a post-splenectomy patient = potential OPSI — immediate parenteral antibiotics
Communication	Clear plan and safety-netting

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging. Children: NOM first-line if stable; treat in dedicated paediatric trauma centres; most do not need angioembolisation.