Nonoperative Management of Adult Blunt Splenic Injury With and Without Splenic Artery Embolotherapy: A Meta-Analysis

Requarth, Jay A.; D’Agostino, Ralph B.; Miller, Preston R.

doi:10.1097/ta.0b013e318227ea50

Cited by 105 publications

(98 citation statements)

References 31 publications

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“…2–4 In adults, SAE has been demonstrated to improve splenic salvage rates for grade IV and V injuries. 12 This point is especially important in the pediatric population, as children have a higher mortality rate from sepsis following splenectomy compared with adults. 13–15,19,20 In our series, we do not know if embolization was proximal or distal, but theoretically, proximal splenic embolization should cause less impairment than selective distal embolization, as it allows the spleen to remain at least partially perfused, reducing risk of infection.…”

Section: Commentsmentioning

confidence: 99%

Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

Rialon

Englum

Gulack

et al. 2016

The American Journal of Surgery

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BACKGROUND Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE. METHODS The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting. RESULTS Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) CONCLUSION Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy.

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Section: Commentsmentioning

confidence: 99%

Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

Rialon

Englum

Gulack

et al. 2016

The American Journal of Surgery

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“…So surgeons make every effort to preserve the spleen using various surgical and nonsurgical approaches [10]. Over the past few decades, nonoperative management (NOM) of blunt splenic injuries (BSI) in hemodynamically stable patients with or without splenic artery embolization (SAE) has been widely accepted and became the standard care currently [11–14]. There are growing evidences suggesting that SAE improves splenic salvage [15–19], as well as preserves the immunologic function of injured spleen [20–22].…”

Section: Introductionmentioning

confidence: 99%

The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

et al. 2017

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BackgroundSplenic artery embolization (SAE) has been an effective adjunct to the Non-operative management (NOM) for blunt splenic injury (BSI). However, the optimal embolization techniques are still inconclusive. To further understand the roles of different embolization locations and embolic materials in SAE, we conducted this system review and meta-analyses.MethodsClinical studies related to SAE for adult patients were researched in electronic databases, included PubMed, Embase, ScienceDirect and Google Scholar Search (between October 1991 and March 2013), and relevant information was extracted. To eliminate the heterogeneity, a sensitivity analysis was conducted on two reduced study sets. Then, the pooled outcomes were compared and the quality assessments were performed using Newcastle-Ottawa Scale (NOS). The SAE success rate, incidences of life-threatening complications of different embolization techniques were compared by χ 2 test in 1st study set. Associations between different embolization techniques and clinical outcomes were evaluated by fixed-effects model in 2nd study set.ResultsTwenty-three studies were included in 1st study set. And then, 13 of them were excluded, because lack of the necessary details of SAE. The remaining 10 studies comprised 2nd study set, and quality assessments were performed using NOS. In 1st set, the primary success rate is 90.1% and the incidence of life-threatening complications is 20.4%, though the cases which required surgical intervention are very few (6.4%). For different embolization locations, there was no obvious association between primary success rate and embolization location in both 1st and 2nd study sets (P > 0.05). But in 2nd study set, it indicated that proximal embolization reduced severe complications and complications needed surgical management. As for the embolic materials, the success rate between coil and gelfoam is not significant. However, coil is associated with a lower risk of life-threatening complications, as well as less complications requiring surgical management.ConclusionsDifferent embolization techniques affect the clinical outcomes of SAE. The proximal embolization is the best option due to the less life-threatening complications. For commonly embolic material, coil is superior to gelfoam for fewer severe complications and less further surgery management.

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“…A recent metaanalysis of nine datasets published between 1994 and 2009 indicated that 68.4% of 10,157 patients were managed nonoperatively. 2 Thus, the OM rate in this study is not high when compared with that of other published studies. 1,2 We believe this finding is important when assessing our protocol for selecting candidates suitable for SP.…”

mentioning

confidence: 44%

“…Although the percentage of operative management (OM) varies among institutions, a general decreasing trend exists. 1,2 Prevalence of NOM, with or without arterial embolization (AE), makes salvage procedures (SP), including splenorrhaphy or partial resection of the spleen, rather infrequent procedures. In addition, if hemodynamic conditions deteriorate, the decision to choose SP decreases accordingly.…”

Section: Introductionmentioning

confidence: 99%

Protocol for splenic salvage procedures in this era of non‐operative management

Mitsusada

2014

Acute Medicine & Surgery

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Aim:The increased prevalence of non-operative management of splenic injuries contributes to the infrequent use of salvage procedures. Nevertheless, salvage procedures are sometimes required. The study aimed to evaluate the safety and feasibility of our salvage procedure protocol for selected patients.Methods: This retrospective study included 27 splenic injury patients divided into two groups: those treated by salvage procedures (splenorrhaphy or partial resection) and those who underwent splenectomy. Our salvage procedure protocol was applied in the following situations: if hemodynamics were stable during laparotomy or bleeding was fully controlled by manual or incisional mobilization of the organ, when no more than two other organs required repair, and if no clinical coagulopathy existed. Results:The splenic abbreviated injury scale, intraoperative bleeding, and transfusion requirements of packed red blood cells and fresh frozen plasma requirements in 24 h were significantly lower in the salvage procedure group. There was no difference in the injury severity score, initial amount of bleeding, length of intensive care unit stay, or morbidity and mortality rates between the groups. Patients who underwent salvage procedures were managed without major complication, except one pseudoaneurysm case. Conclusion:We confirmed the feasibility of our salvage procedure protocol for selected patients, particularly for those with simple or lower grade injuries.

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Nonoperative Management of Adult Blunt Splenic Injury With and Without Splenic Artery Embolotherapy: A Meta-Analysis

Cited by 105 publications

References 31 publications

Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population

The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

Protocol for splenic salvage procedures in this era of non‐operative management

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