Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma

Cirrhosis increases mortality and splenectomy rates following splenic injury

“…2,9 Despite a pathophysiology that includes portal hypertension, splenomegaly, and thrombocytopenia and its association with mortality in all trauma patients, cirrhosis has not been classically appreciated as a risk factor for failing NOM of BSI or requiring an immediate splenectomy. [10][11][12] A series of 12 patients demonstrated that 92% of patients with cirrhosis and BSI required a splenectomy, while a recent analysis of the National Trauma Data Bank (NTDB) demonstrated increased risk of failed NOM and mortality in cirrhotic patients with BSI.…”

Predictors of failure in non-operative management of blunt liver trauma

“…1,14,17 Most prior studies concluded that the main reason for the failure of NOM is the hemodynamic instability, whereas this observation was contradicted by Mitsusada et al 18,19 Various predictors of NOM failure have been documented in the literatures. [20][21][22][23][24][25][26][27][28][29] Literature review of Bhangu et al, reported AAST grades 4-5, the presence of moderate or large hemoperitoneum, increasing ISS and increasing age were significantly associated with increased risk factor of NOM failure in blunt liver injuries. 21 Patients with a lower GCS and higher ISS predicts the failure of NOM that is chosen to treat the patient.…”

“…[20][21][22][23][24][25][26][27][28][29] Literature review of Bhangu et al, reported AAST grades 4-5, the presence of moderate or large hemoperitoneum, increasing ISS and increasing age were significantly associated with increased risk factor of NOM failure in blunt liver injuries. 21 Patients with a lower GCS and higher ISS predicts the failure of NOM that is chosen to treat the patient. This result is consistent with the study of Yanar et al, even though age and male has no role in predicting failure of NOM in blunt liver injuries.…”

Management and outcome of patients with blunt splenic injury and preexisting liver cirrhosis

“…7 In the general population, Grade 4 to 5 splenic injury, moderate or large hemoperitoneum, and increased ISS and age have all been associated with failed NOM. 4 Moreover, a recently published review of general patients 5 found that age greater than 40 years, ISS greater than 25, and splenic injury grade of 3 or higher correlated with mortality. Similar to the identification of NOM predictors, the delineation of these mortality predictors could potentially help in the selection process of BSI LC patients to NOM or immediate surgery.…”

“…1Y3 Recognized predictors of failed NOM include increasing age, higher Injury Severity Score (ISS), splenic injury grade (Q3), a high hemoperitoneum score, a ''blush'' on computed tomographic scan, and hypotension. 4,5 Although liver cirrhosis (LC) induces many factors that could potentially lead to the exacerbation of BSI and failed NOM, such as portal hypertension, splenomegaly, coagulopathy, thrombocytopenia, malnutrition, and jaundice, its effect on the management and outcome of these patients has been poorly studied. Presently, there has been only one previous article, which directly addressed this issue.…”