Contribution of Age and Gender to Outcome of Blunt Splenic Injury in Adults: Multicenter Study of the Eastern Association for the Surgery of Trauma

Harbrecht, Brian G.; Peitzman, Andrew B.; Rivera, Louis; Heil, Brian V.; Croce, Martin A.; Morris, John A.; Enderson, Blaine L.; Kurek, Stanley; Pasquale, Michael D.; Frykberg, Eric R.; Minei, Joseph P.; Meredith, J. Wayne; Young, Joseph C.; Kealey, Gerald P.; Ross, Steven E.; Luchette, Fred A.; McCarthy, Mary C.; Davis, Frank E.; Shatz, David V.; Tinkoff, Glenn; Block, Ernest F. J.; Cone, John B.; Jones, Larry M.; Chalifoux, Thomas M.; Federle, Michael; Clancy, Keith D.; Ochoa, Juan B.; Fakhry, Samir M.; Townsend, Ricard N.; Bell, Richard M.; Weireter, Leonard J.; Shapiro, Michael B.; Rogers, Fred B.; Dunham, C. Michael; McAuley, Clyde E.

doi:10.1097/00005373-200111000-00010

Cited by 111 publications

(62 citation statements)

References 28 publications

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“…The reported durations of observation after BSI have varied widely in the literature, with most studies reporting mean lengths of stay between 4.1 and 12 days. [6,7] Mean hospital stay among our patients was 12.8 days in the splenectomy group and 8.3 days in the nonoperative group, which is longer than the international average, and may be attributed to the nature of the associated injuries.…”

Section: Discussionmentioning

confidence: 75%

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: Discussionmentioning

confidence: 75%

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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“…12,13,[39][40][41][42][43][44][45][46][47][48][49] Most studies were retrospective, single-institution studies of relatively small numbers of patients and likely reflected the criteria and practices of individual surgeons. We found 1 well-designed, multi-institutional retrospective cohort study in our literature review that described rates of failure for NOM based on the initial grade of splenic injury and reported the probability of hypotension and transfusion stratified by grade of splenic injury in patients …”

Section: Nonoperative Managementmentioning

confidence: 99%

“…This would correspond to grade IV and V splenic injuries. The 2 strategies were equivalent for patients with grade III splenic injuries (probability of failure = 0.2); reasons to perform immediate splenectomy on patients with grade III splenic injuries would include other predictors of failure of NOM, such as age older than 55 years 40,41 and arterial contrast extravasa tion on computed tomography. 57 For military patients who may face prolonged transport from a field hospital to a Role 4 facility outside of the theatre of operations, the risk of bleeding to death while in flight likely pushes the decision-making around grade III splenic injuries to favour immedi ate splenectomy, if there were a concomitant severe brain injury.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Blunt splenic injury and severe brain injury: a decision analysis and implications for care

2015

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Background:The initial nonoperative management (NOM) of blunt splenic injuries in hemodynamically stable patients is common. In soldiers who experience blunt splenic injuries with concomitant severe brain injury while on deployment, however, NOM may put the injured soldier at risk for secondary brain injury from prolonged hypotension. Methods:We conducted a decision analysis using a Markov process to evaluate 2 strategies for managing hemodynamically stable patients with blunt splenic injuries and severe brain injury -immediate splenectomy and NOM -in the setting of a field hospital with surgical capability but no angiography capabilities. We considered the base case of a 40-year-old man with a life expectancy of 78 years who experienced blunt trauma resulting in a severe traumatic brain injury and an isolated splenic injury with an estimated failure rate of NOM of 19.6%. The primary outcome measured was life expectancy. We assumed that failure of NOM would occur in the setting of a prolonged casualty evacuation, where surgical capability was not present. Results:Immediate splenectomy was the slightly more effective strategy, resulting in a very modest increase in overall survival compared with NOM. Immediate splenectomy yielded a survival benefit of only 0.4 years over NOM. Conclusion:In terms of overall survival, we would not recommend splenectomy unless the estimated failure rate of NOM exceeded 20%, which corresponds to an American Association for the Surgery of Trauma grade III splenic injury. For military patients for whom angiography may not be available at the field hospital and who require prolonged evacuation, immediate splenectomy should be considered for grade III-V injuries in the presence of severe brain injury.Contexte : La gestion non chirurgicale (GNC) initiale des traumatismes spléniques fermés chez les patients hémodynamiquement stables est fréquente. Toutefois, dans les cas de traumatismes spléniques fermés accompagnés de graves lésions cérébrales concomitantes durant leur déploiement, la GNC peut exposer les soldats blessés à un risque de lésion cérébrale secondaire par suite d'une hypotension prolongée.Méthodes : Nous avons appliqué un modèle de Markov à l'analyse décisionnelle pour évaluer 2 stratégies de prise en charge des patients hémodynamiquement stables porteurs de traumatismes spléniques fermés et de graves lésions cérébrales, soit la splénectomie immédiate et la GNC, dans le contexte d'un hôpital de campagne doté d'installations chirurgicales mais non d'installations angiographiques. Nous avons étudié le scénario de référence d'un homme de 40 ans ayant une espérance de vie de 78 ans, victime d'un traumatisme fermé entraînant une lésion cérébrale grave et un traumatisme splénique isolé, avec un taux estimé d'échec de la GNC de 19,6 %. Le principal paramètre mesuré était l'espérance de vie. Nous avons présumé que l'échec de la GNC surviendrait dans le contexte d'une évacuation prolongée des blessés en l'absence d'installations chirurgicales.Résultats : La splénectomie immédiate s'est...

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“…Em um grande estudo multicêntrico realizado nos Estados Unidos, foi identificado que pacientes com idade superior a 55 anos tem uma maior probabilidade de ter complicações associadas à conduta não operatória devido a falta de reservas fisiológicas (STEIN, 2006;PEREIRA JÚNIOR, 2007;HARBRECT et al, 2001) o que ressalta o destaque de tal conduta entre pacientes jovens e, especialmente, os atendidos na pediatria.…”

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Conduta Expectante (Não Cirurgica) Em Pacientes Pediátricos Vítimas De Trauma Abdominal Contuso Com Lesão De Baço E/Ou Fígado

Castro¹,

Cavalcante²,

Kairala³

2018

PIC

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O trauma abdominal contuso e seu impacto na morbidade e mortalidade de pacientes pediátricos exige condutas eficazes para reduzir riscos e aumentar as taxas de sobrevida com qualidade. Nesse contexto, as condutas não-cirúrgicas têm grande relevância nos cenários de trauma, com menores índices de complicações associadas aos atos cirúrgicos. O objetivo desse estudo foi analisar o perfil de pacientes e os fatores relacionados a falha do tratamento não cirúrgico em pacientes com lesão esplênica e/ou hepática após trauma abdominal fechado internados em um hospital de referência para trauma no DF.Estudo quantitativo, descritivo e retrospectivo com análise de prontuários de crianças entre 0 e 16 anos atendidas em hospital terciário pela equipe de cirurgia pediátrica, entre os anos de 2012 e 2016, vítimas de trauma abdominal contuso com lesão hepática e/ou esplênica e que foram submetidos a tratamento expectante(CE) ou não cirúrgico.

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Contribution of Age and Gender to Outcome of Blunt Splenic Injury in Adults: Multicenter Study of the Eastern Association for the Surgery of Trauma

Abstract: Patients > or = 55 had a greater mortality for all forms of treatment of their blunt splenic injury and failed NOM more frequently than patients < 55. Women > or = 55 had significantly greater mortality and failure of NOM than women < 55.

Cited by 111 publications

References 28 publications

Splenic trauma - our experience at a level I Trauma Center

Splenic trauma - our experience at a level I Trauma Center

Blunt splenic injury and severe brain injury: a decision analysis and implications for care

Conduta Expectante (Não Cirurgica) Em Pacientes Pediátricos Vítimas De Trauma Abdominal Contuso Com Lesão De Baço E/Ou Fígado

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