Failure of Nonoperative Management of Splenic Injuries

Abstract

Presenting patient characteristics can predict which patients will fail nonoperative therapy of blunt splenic injuries.

The efficacy and safety of non operative management in abdominal injury in a high volume but resource stretched setting

“…20 Age did not appear to be risk factor for failed NOM as mean age in NOM-F was (30) compared to mean age (35) in the NOM -S group. AIS for extra abdominal and intra-abdominal injury were higher in the failed group than the successful group.…”

Incidental Splenic Injury and Splenectomy: An Overview Based on Available Evidence

“…Thirty-nine articles in extensive were discarded for failing to meet the eligibility criteria. Finally, the population in study consisted of 35 articles, 3 of evidence level type 3a (Renzulli et al, 2009;He et al, 2014;Piccolo et al, 2014), 32 of evidence level type 4 (Bagrodia et al, 2014;Barmparas et al, 2015;Bracale et al, 2013;Cassar & Munro, 2009;Coon, 1990;Chung et al, 2011;Davies et al, 2014;Eaton et al, 2000;Eber et al, 1999;Edgren et al, 2014;Flum et al, 2001;Geraci et al, 2014;Gómez Alonso et al, 2001;Ha & Minchin, 2009;Harbrecht et al, 2008;Holubar et al, 2009;Kamath et al, 2009;Malek et al, 2007;Masoomi et al, 2012;McIntyre et al, 2005;Merchea et al, 2012;Nikolaev et al, 1990;Ong et al, 1991;Paredes et al, 2013;Rogers et al, 1980;Singla, et al, 2012;Tan et al, 2011;Urschel, 1993;Wang et al, 2011;Yong et al, 2010; and 1 of evidence level type 5 (American Society for Metabolic & Bariatric Surgery, 2012).…”

“…Of the 2243 patients in study, 610 (27 %) underwent immediate splenectomy, splenorrhaphy, or splenic embolization within 4 hours. Of the remaining 1633 who were admitted with planned nonoperative treatment, 252 patients (15 %) failed; founding that being older than 55 years and having an Injury Severity Score higher than 25 were significantly associated with failure, which increases the risk of postoperative mortality, because unrecognized splenic bleeding is a primary cause of preventable mortality (Evidence level type 4) (McIntyre et al, 2005).…”

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

“…NOM is not proper management option in elderly patients, especially 55 years and over (18,19,20). Rodrigeus et al (21), proposed that contraction and retraction of intra-parenchymal vessels are limited due to less elastic splenic capsule with increasing age.…”