Die Behandlungspraxis bei Patienten mit isolierter stumpfer Milzverletzung

Schnüriger, Beat; Martens, F.; Eberle, B.M.; Renzulli, Pietro; Seiler, Christian; Candinas, Daniel

doi:10.1007/s00113-011-2044-4

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…A major component of the interpretation bias of guidelines is the failure for treatment pathways to adequately consider splenic function and instead place a weighted focus on mortality as the only endpoint [ 4 ]. This is also in part because it is difficult to measure treatment success in trauma and most studies in this context are retrospective with several inherent biases, leading to scepticism of results and lack of applicability of approaches where trauma systems aren’t replicable [ 6 , 8 ]. In addition to these challenges, interventional radiology is still a young specialty, and as such training and governance structures vary significantly between different hospitals, regions, and countries [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

A systematic review assessing incorporation of prophylactic splenic artery embolisation (pSAE) into trauma guidelines for the management of high-grade splenic injury

Clements,

Fitzgerald,

Chennapragada

et al. 2023

CVIR Endovasc

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Background Splenic artery embolisation (SAE) has become a vital strategy in the modern landscape of multidisciplinary trauma care, improving splenic salvage rates in patients with high-grade injury. However, due to a lack of prospective data there remains contention amongst stakeholders as to whether SAE should be performed at the time of presentation (prophylactic or pSAE), or whether patients should be observed, and SAE only used only if a patient re-bleeds. This systematic review aimed to assess published practice management guidelines which recommend pSAE, stratified according to their quality. Methods The study was registered and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Medline, PubMed, Cochrane, Embase, and Google Scholar were searched by the study authors. Identified guidelines were graded according to the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument. Results Database and internet searches identified 1006 results. After applying exclusion criteria, 28 guidelines were included. The use of pSAE was recommended in 15 guidelines (54%). This included 6 out of 9 guidelines that were high quality (66.7%), 4 out of 9 guidelines that were moderate quality (44.4%), and 3 out of 10 (30%) guidelines that were low quality, p = 0.275. Conclusions This systematic review showed that recommendation of pSAE is more common in guidelines which are of high quality. However, there is vast heterogeneity of recommended practice guidelines, likely based on individual trauma systems rather than the available evidence. This reflects biases with interpretation of data and lack of multidisciplinary system inputs, including from interventional radiologists.

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Section: Discussionmentioning

confidence: 99%

A systematic review assessing incorporation of prophylactic splenic artery embolisation (pSAE) into trauma guidelines for the management of high-grade splenic injury

Clements,

Fitzgerald,

Chennapragada

et al. 2023

CVIR Endovasc

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show abstract

“…Over the past decades, non-operative management (NOM) of blunt splenic or liver injuries has become the standard of care in hemodynamically stable patients [1][2][3][4]. At our center, 80% of blunt liver and splenic injuries underwent successful NOM, including patients that required angioembolization [5,6].…”

Section: Introductionmentioning

confidence: 99%