Trauma centers with higher rates of angiography have a lesser incidence of splenectomy in the management of blunt splenic injury

Capecci, Louis M.; Jeremitsky, Élan; Smith, R. Stephen; Philp, Frances Hite

doi:10.1016/j.surg.2015.05.025

Cited by 30 publications

(24 citation statements)

References 10 publications

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“…These results are similar to the results of previous studies [11, 12]. The well-established infrastructure, facilities for immediate resuscitation and angiography, 24-h availability of the ICU and confidence of the trauma team might be influencing factors of this result [13].…”

Section: Discussionsupporting

confidence: 90%

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Liao

et al. 2019

Scand J Trauma Resusc Emerg Med

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BackgroundThe long-term treatment trends of splenic injuries can provide guidance when treating trauma patients. The nonoperative management (NOM) of splenic injuries was introduced in early 1989. After decades of development, it has proven to be safe and is now the primary treatment choice worldwide. However, there remains a lack of nationwide registry data to support the feasibility and efficiency of NOM.MethodsWe used the Taiwan National Health Insurance Research Database to conduct a whole population-based cohort study. Patients admitted with blunt splenic injuries from 2002 to 2013 were identified. Demographic data, management methods, associated injuries, comorbidities and outcome parameters were collected. Patients were divided into 2 groups by the type of admitting institution: a tertiary center or a non-center hospital. We also used 4 years as an interval to analyze the changes in epidemiological data and treatment trends. Comparisons of the results of NOM and surgical management were also performed.ResultsA total of 12,455 patients were admitted with blunt splenic injuries between 2002 and 2013. Among the 11,551 patients treated in a single hospital after admission, patients underwent NOM more frequently at tertiary centers than at non-center hospitals (64.6% vs 50.3%). During the 12-year study period, the NOM rate increased from 56 to 73% in tertiary centers, while in noncenter hospitals, the rate only increased from 43 to 58%. The mortality rate decreased in tertiary centers from 8.9 to 7.2%, with no apparent change in noncenter hospitals. Complications occurred more frequently in the surgical management group.ConclusionThere is a trend toward the use of NOM for blunt splenic injury treatments, and the outcomes from the NOM groups were not inferior to those of the operation group. In addition, tertiary centers performed more NOM than did non-center hospitals and better met the international consensus.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0578-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Liao

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…As in some other previous studies, we reported a very low NOM failure rate [14,15,17] and this could be related to the high rate of blunt abdominal trauma with splenic injury that underwent splenic angioembolization after the CT performed in the ED in our cohort. In fact, a previous study demonstrated that high splenic angioembolization rates could reduce NOM failure [18].…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

2019

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Aims: To assess contrast enhanced ultrasound (CEUS) performance in the prediction of non-operatively managed blunt spleen injuries requiring only observation and monitoring during follow-up and to evaluate if CEUS accuracy was higher than conventional ultrasound (US) in this field.Material and methods: In 112 hemodynamic stable blunt spleen trauma patients, CEUS was performed for follow-up after computed tomography evaluation in the emergency department. CEUS and US performance were assessed considering as true negative cases patients that had not underwent interventional or surgical treatment during follow-up and were assessed as negative for splenic complications respectively by CEUS or US examinations.Results: CEUS showed sensitivity of 100%, specificity of 96.1%, positive predictive value of 69.2%, negative predictive value of 100.0% and accuracy of 96.4%. CEUS showed a significantly higher accuracy than conventional US (p=0.013).Conclusions: CEUS is a very useful imaging modality during follow-up of blunt splenic trauma non-operatively managed, allowing an efficientprediction of splenic injuries requiring only observation and monitoring during follow-up.

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“…Arterial blush on CT in the absence of angio-embolization is described as a risk factor of conservative treatment failure (5,8,18), as well as diffuse hemoperitoneum (14,16).…”

Section: Discussionmentioning

confidence: 99%

“…The gold-standard treatment for patients with splenic injury in blunt abdominal trauma with stable hemodynamic status is the non-operative management (NOM), which is performed in approximately 80% of patients (5,6). This medical management is effective in 62 to 92% of cases, likely because of the increasingly frequent use of splenic angioembolization (5,(7)(8)(9)(10). It is di cult to identify patients who will have NOM failure and require secondary splenectomy (5,6,(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Failure Risk Factor For Non-Operative Treatment of Splenic Trauma

Maubert

Douissard²,

Tokoto³

et al. 2020

Preprint

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Abstract Background: Splenic trauma is a common pattern for admission in blunt abdominal trauma. The objective of this study is to identify risk factors for failure of non-operative management (NOM) in splenic trauma.Methods: This is a retrospective monocentric analysis of a prospectively collected database. All patients admitted in the university hospital of Nice [Centre Hospitalier Universitaire (CHU) de Nice, France] for a splenic trauma from January 1st 2006 to January 6th 2018 were included. Primary outcome was the need for delayed splenectomy as an indicator of NOM failure.Results: Two-hundred-eighty patients were included in this study. Most splenic lesions were severe grades (grade 3 or higher). In total, 83 splenectomies were performed urgently, i.e. 29% of patients; 88 angio-embolizations, i.e., 31% of patients with a success rate greater than 80%; 14.7% of 136 patients who had no previous angio-embolization required secondary splenectomy; 19.7% of the 61 patients who had anterior angio-embolization required secondary splenectomy. Age was not found associated with a higher failure rate (44 years in successful embolization vs 37.5 years in NOM-failure group, p = 0.15). Higher drop in hemoglobin levels between admission and 6 hours after admission was detected in the embolization failure group (-1.44 g/dl) as compared with the successful group (-0.68 g/dl), which approached statistical significance (p = 0.064).Conclusions: Hemoglobin monitoring in the hours following the admission of a patient with splenic trauma might be an important factor during the medical supervision of hemodynamically stable patients. Early identification of patients at high risk of NOM failure by hemoglobin monitoring may prevent late splenectomy.Level of evidence: IV (retrospective study)

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Trauma centers with higher rates of angiography have a lesser incidence of splenectomy in the management of blunt splenic injury

Cited by 30 publications

References 10 publications

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

Failure Risk Factor For Non-Operative Treatment of Splenic Trauma

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