The role of grade of injury in non-operative management of blunt hepatic and splenic trauma
| Autor: | Amilcare Parisi, Paolo Ruscelli, Roberto Candelari, Roberto Cirocchi, Rita Commissari, Claudio Renzi, Vittorio Marconi, A Santoro, Sergio Santella, Marzia Rosati, Massimiliano Rimini, Vito D'Andrea, Enrico Paci, Alessandro Gemini |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment angiography embolization hemodynamic stability liver trauma non-operative management splenic trauma trauma Abdominal Injuries Aged Conservative Treatment Female Fluid Therapy Humans Injury Severity Score Liver Male Middle Aged Retrospective Studies Spleen Trauma Centers Wounds Nonpenetrating Splenectomy Retrospective cohort study General Medicine medicine.disease Surgery 03 medical and health sciences Pseudoaneurysm 0302 clinical medicine Blunt Clinical pathway Abdominal trauma 030220 oncology & carcinogenesis Orthopedic surgery medicine 030212 general & internal medicine business |
| Zdroj: | Medicine. 98:e16746 |
| ISSN: | 1536-5964 0025-7974 |
| Popis: | This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions.We conducted a retrospective study applied on a patient's cohort, admitted in "Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona" and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions.From October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Each patient underwent CT scan at his admission. No contrast pooling was found in 50 pts. (45.04%). Contrast pooling was found in 61 patients (54.95%). The NOM overall outcome resulted in success in 107 patients (96.4%). NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II).Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale. |
| Databáze: | OpenAIRE |
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