Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study

Smith, Stella; Morris, Louise; Spreadborough, Stephen; Al-Obaydi, Waleed; D’Auria, Marta; White, Hilary; Brooks, Adam

doi:10.1007/s00068-017-0807-5

Cited by 26 publications

(20 citation statements)

References 35 publications

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“…Hypotension in the field and on initial presentation to the ED, large volume blood transfusion, altered mental status, age above 55 years, hemoperitoneum volume > 250 ml, higher ISS/AAST-OIS grade, associated abdominal injuries, and splenic vascular abnormalities (pseudoaneurysms, arteriovenous fistulae or contrast blushes) have all been identified as risk factors for NOM failure [28][29][30][31]. Similarly, factors including subcapsular hematoma and intra-peritoneal contrast blush on CT scan have been suggested as additional independent risk factors for requiring splenectomy [6,32]. NOM (± AE) failures after penetrating splenic injuries in stable patients can be particularly common, due to the frequent high grade of splenic trauma and the high rate of diaphragmatic lacerations (up to 60%) and other visceral injuries that require immediate laparotomy [33].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

et al. 2021

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Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

et al. 2021

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“…The audience’s position on the latter of these aspects is supported in the literature [ 6 ]. Haemodynamic instability normally corresponds to intravenous fluid requirement and has in fact proved non-significant as predictor of non-operative management failure in a recent publication by Smith et al [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The three areas of disagreement represent an interesting result of this work. Although some authors report a direct correlation between the overall injury severity and non-operative management failure, other groups showed different findings [ 11 , 13 ]. This ambiguity is reflected in the answers we collected, with no agreement reached on the role of multiple injuries.…”

Section: Discussionmentioning

confidence: 99%

Grade III blunt splenic injury without contrast extravasation - World Society of Emergency Surgery Nijmegen consensus practice

et al. 2020

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Background: Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Nevertheless, such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach. Methods: A questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES). This was delivered and answered live by acute care surgeons attending the 6 th WSES congress in Nijmegen in 2019. A dedicated mobile phone application was utilized to collect the answers. All answers were evaluated for areas of discrepancy with an 80% threshold for consensus between respondents. Results: Three factors generated discrepancy in opinion for managing this pattern of injury: the patients' injury severity, the presence of a bleeding diathesis, and an associated intra-abdominal injury. Agreement was obtained for the other eight factors. Conclusion: Researchers should focus their efforts on the identified area of discrepancy. Clinicians should use additional care in the presence of the three factors for which discordant opinions were found.

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“…In developing countries, traumas are among the main causes of mortality and morbidity under the age of 45. The abdomen is the third most frequently injured part of the body (1). Approximately 7.5% of trauma patients in Turkey are treated in the general surgery department (2).…”

Section: Introductionmentioning

confidence: 99%

Non-surgical follow-up success in blunt abdominal trauma. Can we protect patients with blunt abdominal trauma from surgery?

Yıldırım

Şahiner

Kendirci

et al. 2021

Journal of Health Sciences and Medicine

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Backgrounds: Abdominal traumas have an important place in the emergency room. Historically, surgical intervention was adopted as a treatment method for liver and spleen traumas. However, with the development of imaging methods, the possibility of non-surgical follow-up was obtained. In this study, the advantages and disadvantages of conservative treatment for surgical intervention were investigated. Material and Method:The patients with complaints of blunt abdominal trauma, who were admitted to the third step research center emergency service during the 27-month period and were referred to general surgery, were retrospectively examined.Results: Of patients, 58.2% (n=53) was monitored conservatively, 34.1% (n=31) had splenectomy and 4.4% (n=4) underwent the primary repair due to isolated liver injury, and both splenectomy and liver primary repair were performed in 3.3% (n=3) because of multiple solid organ injury. We observed that the injuries of non-surgical spleen trauma patients changed between grade I and III. All patients with grade IV-V injuries underwent splenectomy. Patients with decreased hematocrit and whose hematocrit did not increase despite erythrocyte replacement were operated on. Conclusion:In this study, it was explained that patients who were followed up without surgery did not need surgery and that both liver trauma and spleen trauma should be given the chance to follow up without surgery.

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Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study

Abstract: Higher grade injuries (III-V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM ± AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24 h with appropriate advice.

Cited by 26 publications

References 35 publications

Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

Grade III blunt splenic injury without contrast extravasation - World Society of Emergency Surgery Nijmegen consensus practice

Non-surgical follow-up success in blunt abdominal trauma. Can we protect patients with blunt abdominal trauma from surgery?

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