Angioembolization in patients with blunt splenic trauma in Germany -guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®.

Autor: Kölbel B; Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. benny.koelbel@googlemail.com., Imach S; Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany., Engelhardt M; Department of Vascular and Endovascular Surgery, German Armed Forces Hospital Ulm, Ulm, Germany., Wafaisade A; Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany., Lefering R; Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany., Beltzer C; Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2024 Oct; Vol. 50 (5), pp. 2451-2462. Date of Electronic Publication: 2024 Sep 16.
DOI: 10.1007/s00068-024-02640-6
Abstrakt: Purpose: Nonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guideline. The objectives were to study treatment modalities in the adult BSI population according to different severity parameters including NOM, ANGIO and splenectomy in Germany.
Methods: Between 2015 and 2020, a retrospective registry-based cohort study was performed on patients with BSIs with an Abbreviated Injury Score ≥ 2 in Germany using registry data from the TraumaRegister DGU® (TR DGU). This registry includes patients which were treated in a resuscitation room and spend more than 24-h in an intensive care unit or died in the resuscitation room.
Results: A total of 2,782 patients with BSIs were included in the analysis. ANGIO was used in 28 patients (1.0%). NOM was performed in 57.5% of all patients, predominantly those with less severe organ injuries measured by the American Association for the Surgery of Trauma Organ Injury Scale (AAST) ≤ 2. The splenectomy rate for patients with an AAST ≥ 3 was 58.5%, and the overall mortality associated with BSI was 15%.
Conclusions: In this cohort splenic injuries AAST ≥ 3 were predominantly managed surgically and ANGIO was rarely used to augment NOM. Therefore, clinical reality deviates from guideline recommendations regarding the use of ANGIO and NOM. Local interdisciplinary treatment protocols might close that gap in the future.
Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval and consent to participate: This study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. The study was performed following the current publication guidelines of the TR DGU and is registered as a TR-DGU project (ID: TR-DGU 2021–015). According to the guidelines of the responsible state medical association, ethical approval was not required since the study was a retrospective analysis based on pseudonymous aggregated routine data. Consent for publication: Not applicable.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: