Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

Rialon, Kristy L.; Englum, Brian R.; Gulack, Brian C.; Guevara, Carlos J.; Bhattacharya, Syamal D.; Shapiro, Mark L.; Rice, Henry E.; Scarborough, John; Adibe, Obinna O.

doi:10.1016/j.amjsurg.2015.06.009

Cited by 16 publications

(11 citation statements)

References 31 publications

(34 reference statements)

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“…As shown in Table 2, tertiary centers had a higher percentage of patients with an ISS ≥ 16 than noncenter hospitals during every period of the study. These results are similar to the results of previous studies [11, 12]. The well-established infrastructure, facilities for immediate resuscitation and angiography, 24-h availability of the ICU and confidence of the trauma team might be influencing factors of this result [13].…”

Section: Discussionsupporting

confidence: 90%

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Liao

et al. 2019

Scand J Trauma Resusc Emerg Med

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BackgroundThe long-term treatment trends of splenic injuries can provide guidance when treating trauma patients. The nonoperative management (NOM) of splenic injuries was introduced in early 1989. After decades of development, it has proven to be safe and is now the primary treatment choice worldwide. However, there remains a lack of nationwide registry data to support the feasibility and efficiency of NOM.MethodsWe used the Taiwan National Health Insurance Research Database to conduct a whole population-based cohort study. Patients admitted with blunt splenic injuries from 2002 to 2013 were identified. Demographic data, management methods, associated injuries, comorbidities and outcome parameters were collected. Patients were divided into 2 groups by the type of admitting institution: a tertiary center or a non-center hospital. We also used 4 years as an interval to analyze the changes in epidemiological data and treatment trends. Comparisons of the results of NOM and surgical management were also performed.ResultsA total of 12,455 patients were admitted with blunt splenic injuries between 2002 and 2013. Among the 11,551 patients treated in a single hospital after admission, patients underwent NOM more frequently at tertiary centers than at non-center hospitals (64.6% vs 50.3%). During the 12-year study period, the NOM rate increased from 56 to 73% in tertiary centers, while in noncenter hospitals, the rate only increased from 43 to 58%. The mortality rate decreased in tertiary centers from 8.9 to 7.2%, with no apparent change in noncenter hospitals. Complications occurred more frequently in the surgical management group.ConclusionThere is a trend toward the use of NOM for blunt splenic injury treatments, and the outcomes from the NOM groups were not inferior to those of the operation group. In addition, tertiary centers performed more NOM than did non-center hospitals and better met the international consensus.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0578-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Liao

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…A primary concern in the case of patients with splenic injuries is the possibility of a delayed rupture after discharge. Based on the evidence, it was concluded that there is no difference between the survival rate in splenic trauma patients with surgical and non-surgical approaches (Rialon et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

Comparison of Surgical and Non-Surgical Approaches to Splenic Trauma

Mousavie¹,

Rizi²,

Hosseinpour³

et al. 2020

PTQ

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The spleen loss leads to increase the risk of sepsis, pyelonephritis, pneumonia, and pulmonary embolism throughout the lifetime of patients with splenic trauma. Regarding the sensitivity of the spleen and the importance of appropriate therapies for spastic trauma, this study aimed to determine the consequences of spinal trauma based on different therapeutic methods. This retrospective cohort study was conducted on the splenic trauma patients who were referred to Rasool Akram Hospital in Tehran, Iran, during 2011-2017. All medical records of 133 splenic trauma patients were gathered from 2011-2017. The data were gathered related to ultrasound, and computed tomography scan or other diagnostic methods of the patients admitted in the surgical ward. Finally, splenic trauma patients with a surgical approach were compared to the subjects with a non-surgical approach. Surgical and non-surgical approaches were performed on 80% (n=104) and 20% (n=26) of the subjects, respectively. There was a significant difference between the two groups regarding the length of intensive care unit stay and total hospitalization duration. The comparison between the two groups showed that there was no significant difference in term of the related side effects (P>0.05). Overall, 80.8% (n=84) and 96.4% (n=27) of the patients were discharged in surgical and non-surgical groups, respectively. In addition, 19.2% (n=20) and 3.6% (n=1) of the cases died in surgical and non-surgical groups. The comparison of survived patients showed that there was a significant difference between the groups (P=0.045). This study showed that there was no difference regarding the consequences of surgical and non-surgical approaches in patients with splenic trauma. The length of hospital stay was shorter in the non-surgical group, compared to that of the surgical group. The most commoncause of trauma in both groups was car accidents. Retroperitoneal hematoma was the most common intraabdominal trauma. The mortality rate was higher in the surgical group in comparison to that of the non-surgical group.

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“…Prior success rates for NOM in the literature for pediatric patients are greater than 90% (14). A prior NTDB study published in 2016 noted a NOM success rate of 90%, with comparable morbidity and mortality rates between SAE and splenectomy in high-grade injuries (15). In addition, the association of NOM with improved clinical outcomes, such as LOS and fewer ICU days, is consistent with other studies showing NOM to be associated with a reduced blood transfusion, shorter LOS, or reduced mortality (16,17).…”

Section: Discussionmentioning

confidence: 99%

Contemporary Management of Pediatric Blunt Splenic Trauma: A National Trauma Databank Analysis

Shinn

Gilyard

Chahine

et al. 2021

Journal of Vascular and Interventional Radiology

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Purpose: To quantify changes in the management of pediatric patients with isolated splenic injury from 2007 to 2015.Materials and Methods: Patients under 18 years old with registered splenic injury in the National Trauma Data Bank (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) were identified. Splenic injuries were categorized into 5 management types: nonoperative management (NOM), embolization, splenic repair, splenectomy, or a combination therapy. Linear mixed models accounting for confounding variables were used to examine the direct impact of management on length of stay (LOS), intensive care unit (ICU) days, and ventilator days.Results: Of included patients (n ¼ 24,128), 90.3% (n ¼ 21,789), 5.6% (n ¼ 1,361), and 2.7% (n ¼ 640) had NOM, splenectomy, and embolization, respectively. From 2007 to 2015, the rate of embolization increased from 1.5% to 3.5%, and the rate of splenectomy decreased from 6.9% to 4.4%. Combining injury grades, NOM was associated with the shortest LOS (5.1 days), ICU days (1.9 days), and ventilator days (0.5 day). Moreover, splenectomy was associated with longer LOS (10.1 days), ICU days (4.5 days), and ventilator days (2.1 days) than NOM. The average failure rate of NOM was 1.5% (180 failures/12,378 cases). Average embolization failure was 1.3% (6 failures/456 cases). Splenic artery embolization was associated with lower mortality than splenectomy (OR: 0.10, P <.001). No statistically significant difference was observed in mortality between embolization and NOM (OR: 0.96, P ¼ 1.0). Conclusions:In pediatric splenic injury, NOM is the most utilized and associated with favorable outcomes, most notably in grades III to V pediatric splenic injury. If intervention is needed, embolization is effective and increasingly utilized most significantly in lower grade injuries.Trauma due to unintentional injury is the leading cause of death in children in the United States (1,2). Blunt trauma is the most common injury (due to falls, motor vehicle injuries, and being struck by an object), and the spleen is one of the most frequently injured intra-abdominal solid organs (3). Isolated splenic injury in blunt trauma accounts for From the Department of Radiology and Imaging Sciences (K.

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Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

Cited by 16 publications

References 31 publications

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Comparison of Surgical and Non-Surgical Approaches to Splenic Trauma

Contemporary Management of Pediatric Blunt Splenic Trauma: A National Trauma Databank Analysis

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