Le traitement non opératoire des traumatismes spléniques sévères fermés est-il le moins morbide ? Résultats d’une étude prospective multicentrique

The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: A systematic review and meta-analysis

“…Complications were reported variably; some papers reported no complications at all 34,35 while others describe serious complications. 33,36,37,40,41,49 Duchesne et al found a four-fold increased risk of Acute Respiratory Distress Syndrome (ARDS) with SAE use when compared to splenectomy. 12 Our metaanalysis found a substantial increase in overall morbidity with SAE, though the higher injury severity in the SAE cohort confounds this finding.…”

“…Three studies, describing 333 patients with BSI, reported overall morbidity rates. 37,38,41 Heterogeneity between these studies was minimal (I 2 = 10.4%).…”

“…13,33,40,41,45 No explicit indication was stated in seven studies. 32,37,38,43,47 Studies frequently cited more than one indication, and clinician discretion was often the overriding factor.…”

“…Definitions of failure also varied. Fifteen papers defined it as progression to splenectomy, 15,20,[32][33][34][35]39,41,42,[44][45][46]49,50 three as evidence of ongoing bleeding, 13,37,43 three as requirement for further procedure, 46,48,51 and two provided no definition. 36,38 Failure Rates Twenty-two studies, describing 6415 patients with BSI, directly compared failure rates for those treated with SAE and those treated with NOM alone.…”

“…36,38 Failure Rates Twenty-two studies, describing 6415 patients with BSI, directly compared failure rates for those treated with SAE and those treated with NOM alone. 13,15,20,[32][33][34][35][36][37][39][40][41][42][43][44][45][46][47][48][49][50][51] There was high heterogeneity between studies (I 2 = 59.5% (Figure 2 and eFigure 2). The average duration from injury to failure of non-operative management was 2.7 (range 0 -25) days.…”