Adult Splenic Injuries: Treatment Patterns and Predictive Indicators

Sanders, Mark N.; Civil, Ian

doi:10.1046/j.1440-1622.1999.01594.x

Cited by 15 publications

(20 citation statements)

References 17 publications

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“…It is stated that hospital stay for NOM patients is shorter than for patients undergoing operative management. [14,15] Similarly, in our study, mean hospital stay for the NOM patients was shorter than for the operated group.…”

Section: Discussionsupporting

confidence: 71%

Splenic trauma - our experience at a level I Trauma Center

Saurabh

Kumar²,

Gupta³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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AMAÇNon-operatif tedavinin dalak travmalı hastalar üzerindeki etkilerini belirlemek üzere, I. Basamak Travma Merkezimizde Ocak 2007 ile Haziran 2008 tarihleri arasında retrospektif bir çalışma yürütüldü. GEREÇ VE YÖNTEMHasta demografisi, dalak yaralanması biçimi, bilgisayarlı tomografi (BT) evrelemesi, kan transfüzyon gereksinimi, cerrahi bulgular, hastanede kalış ve takip ile ilgili bilgiler toplandı. Splenik yaralanmanın kanıtı olarak ve yaralanmanın evresini belirlemek üzere, karın ultrasonografisi ve BT tarama sonuçları kullanıldı. Hastalar splenektomi ve non-operatif gruplarına ayrıldı. Bulgular non-parametrik Mann-Whitney U testiyle analiz edildi. BULGULARAltmış yedi hasta çalışmaya alındı . Evre I yaralanması olan bütün hastalarla evre II yaralanması bulunan 13 hastanın 12'si non-operatif olarak tedavi edilirken, evre III 16 hastanın 9'u, evre IV 14 hastanın 12'si ve evre V bütün hastalar cerrahi yöntemle tedavi edildi. Bu nedenle, ne kadar yük-sek yaralanma derecesi söz konusu ise o kadar çok operatif tedavi gerçekleşti. Operatif grubun ortalama Yaralanma Şiddet Skoru (20,12), non-operatif grubun Yaralanma Şid-det Skorundan (11,9) anlamlı şekilde daha yüksek bulundu (p=0,001). Operatif ve non-operatif gruplardaki ortalama hastane kalışları, sırasıyla 12,8 ve 8,3 gün idi. SONUÇDalak travmasının non-operatif tedavisi kabul edilebilir sonuçlarla uygulanabilmektedir.Anahtar Sözcükler: Splenik travma; splenektomi; non-operatif tedavi.

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Section: Discussionsupporting

confidence: 71%

Splenic trauma - our experience at a level I Trauma Center

Saurabh

Kumar²,

Gupta³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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“…10,11 In our study, hospital stay for non-operatively managed patients was significantly longer than for the operated group. Ten of 11 patients (91%) were successfully discharged following non-operative treatment, a similar figure to that quoted in the literature.…”

Section: Discussionmentioning

confidence: 46%

Recent Changes in the Management of Blunt Splenic Injury: Effect on Splenic Trauma Patients and Hospital Implications

Sinha

Raja

Lewis

2008

annals

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Ann R Coll Surg Engl 2008; 90: 109-112 109Until recently, the accepted treatment for splenic trauma, even for minor injuries, used to be splenectomy. This aggressive approach was based on the belief that, in adulthood, the spleen does not contribute any major function and conservative treatment was associated with potential life-threatening haemorrhage. With increasing recognition of the spleen's role in immunological function and awareness of overwhelming postsplenectomy sepsis (OPSI), there has been an increasing trend towards conservative treatment and splenic salvage procedure. However, this changed policy towards splenic conservation requires careful risk-benefit analysis in the face of potentially life-threatening haemorrhage from delayed splenic rupture and the possibility of transfusion-induced viral infections. Furthermore, the increasing availability of reliable and good quality radiological imaging including ultrasound, computerised tomography (CT) scanning, and magnetic resonance imaging (MRI) have greatly improved the information available with regard to the nature of the splenic injury and this may well help to identify the suitable patients for conservative management, 2 but at the expense of patient radiation.We have reviewed the outcome of splenic injuries from our institution with the main aim of examining the effect of this changed conservative policy on patients and its implications. Patients and MethodsWe have undertaken a retrospective study of patients with blunt splenic injury admitted to our hospital between January 1997 and December 2005. Patients were identified with the help of clinical coding department querying on coding data on PAS (Patient Administration System). Coding data are extracted from various source documentation found in the patient case-note and theatre register. Data regarding patient demography, mode of splenic injury,

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“…Abdominal trauma can be classified as blunt or penetrating according to the agent and its mechanism of action [1-3]. …”

Section: Introductionmentioning

confidence: 99%

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

et al. 2013

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IntroductionThe goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay.MethodsFor this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST.ResultsWe identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison.ConclusionsNOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.

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Adult Splenic Injuries: Treatment Patterns and Predictive Indicators

Abstract: Although these results did not reach statistical significance, by coupling the trends seen together with other work, CT grading of splenic injury is a predictive indicator and does appear to have a role in the early allocation of patients to appropriate treatment plans.

Cited by 15 publications

References 17 publications

Splenic trauma - our experience at a level I Trauma Center

Splenic trauma - our experience at a level I Trauma Center

Recent Changes in the Management of Blunt Splenic Injury: Effect on Splenic Trauma Patients and Hospital Implications

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

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