Prognostic factors for failure of nonoperative management in adults with blunt splenic injury

Olthof, Dominique C.; Joosse, Pieter; Vlies, Cornelis H. van der; Haan, Rob J. de; Goslings, J. C.

doi:10.1097/ta.0b013e31827d5e3a

Cited by 100 publications

(107 citation statements)

References 27 publications

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“…In the review of Olthof et al (1), no evidence was found between hemoglobin/hematocrit levels and predictive factors for NOM failure in patients with blunt splenic trauma. In our study, the rate of NOM failure was higher in patients who required more than 2 IU of RBC in first 24 hours.…”

Section: Discussionmentioning

confidence: 99%

“…However, the absence of a consensus regarding which patients NOM should be administered requires further study. A positive correlation was founded between the splenic trauma grade and NOM failure in many studies (1,10,11,12,13). 217 patients were identified splenic trauma grade of 3 or higher on CT as an independent predictive factor for failure of NOM by Velmahos et al (14).…”

Section: Discussionmentioning

confidence: 99%

“…However, many risk factors have been described in the literature that may lead to failure of NOM. Hemodynamic instability, age above 55 years, multiple organ injuries, higher splenic trauma grade, Injury Severity Score (ISS) and transfusion requirement, lower blood pressure and GCS at admission, degree of hemoperitoneum, and contrast extravasation are patient-related factors frequently reported to be associated with failure of NOM (1,6). However, there is no consensus on the predicting factors that may lead to NOM failure.…”

Section: Introductionmentioning

confidence: 99%

“…In many studies, 78-98% success rates for NOM have been described (1,2,3,4,5). However, many risk factors have been described in the literature that may lead to failure of NOM.…”

Section: Introductionmentioning

confidence: 99%

“…Historically, the best treatment option for patients with traumatic splenic injury was splenectomy (1). Procedures for preservation of the spleen have attracted more attention since the description sepsis of postsplenectomy by Singer (2).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In many studies, 78-98% success rates for NOM have been described (1,2,3,4,5). However, many risk factors have been described in the literature that may lead to failure of NOM.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2015

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Effect of Prophylactic Embolization on Patients With Blunt Trauma at High Risk of Splenectomy

et al. 2020

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IMPORTANCE Splenic arterial embolization (SAE) improves the rate of spleen rescue, yet the advantage of prophylactic SAE (pSAE) compared with surveillance and then embolization only if necessary (SURV) for patients at high risk of spleen rupture remains controversial. OBJECTIVE To determine whether the 1-month spleen salvage rate is better after pSAE or SURV. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial conducted between February 6, 2014, and September 1, 2017, at 16 institutions in France, 133 patients with splenic trauma at high risk of rupture were randomized to undergo pSAE or SURV. All analyses were performed on a per-protocol basis, as well as an intention-to-treat analysis for specific events.INTERVENTIONS Prophylactic SAE, preferably using an arterial approach via the femoral artery, or SURV. MAIN OUTCOMES AND MEASURESThe primary end point was an intact spleen or a spleen with at least 50% vascularized parenchyma detected on an arterial computed tomography scan at 1 month after trauma, assessed by senior radiologists masked to the treatment group. Secondary end points included splenectomy and pseudoaneurysm, secondary SAE after inclusion, complications, length of hospital stay, quality-of-life score, and length of time off work or studies during the 6-month follow-up.RESULTS A total of 140 patients were randomized, and 133 (105 men [78.9%]; median age, 30 years [interquartile range, 23-47 years]) were retained in the study. For the primary end point, data from 117 patients (57 who underwent pSAE and 60 who underwent SURV) could be analyzed. The number of patients with at least a 50% viable spleen detected on a computed tomography scan at month 1 was not significantly different between the pSAE and SURV groups (56 of 57 [98.2%] vs 56 of 60 [93.3%]; difference, 4.9%; 95% CI, −2.4% to 12.1%; P = .37). By the day 5 visit, there were significantly fewer splenic pseudoaneurysms among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 8 of 65 [12.3%]; difference, −10.8%; 95% CI, −19.3% to −2.1%; P = .03), significantly fewer secondary embolizations among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 19 of 65 [29.2%]; difference, −27.7%; 95% CI, −41.0% to −15.9%; P < .001), and no difference in the overall complication rate between the pSAE and SURV groups (19 of 65 [29.2%] vs 27 of 65 [41.5%]; difference, −12.3%; 95% CI, −28.3% to 4.4%; P = .14). Between the day 5 and month 1 visits, the overall complication rate was not significantly different between the pSAE and SURV groups (11 of 59 [18.6%] vs 12 of 63 [19.0%]; difference, −0.4%; 95% CI, −14.4% to 13.6%; P = .96). The median length of hospitalization was significantly shorter for patients in the pSAE group than for those in the SURV group (9 days [interquartile range, 6-14 days] vs 13 days [interquartile range, 9-17 days]; P = .002).CONCLUSIONS AND RELEVANCE Among patients with splenic trauma at high risk of rupture, the 1-month spleen salvage rate was not statistically different between patients...

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Endovascular Treatment for Vascular Trauma

Baer-Bositis¹,

Haidar²,

Hicks³

2018

Endovascular Interventions

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Prognostic factors for failure of nonoperative management in adults with blunt splenic injury

Abstract: Systematic review, level III.

Cited by 100 publications

References 27 publications

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

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

Effect of Prophylactic Embolization on Patients With Blunt Trauma at High Risk of Splenectomy

Endovascular Treatment for Vascular Trauma

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