Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study
| Autor: | Stella R. Smith, Hilary White, Marta D’Auria, Waleed Al-Obaydi, Louise Morris, Adam Brooks, Stephen Spreadborough |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Sports medicine medicine.medical_treatment Blood Component Transfusion 030230 surgery Wounds Nonpenetrating Critical Care and Intensive Care Medicine 03 medical and health sciences Pseudoaneurysm Injury Severity Score 0302 clinical medicine Blunt Trauma Centers Predictive Value of Tests Risk Factors medicine Humans Orthopedics and Sports Medicine Treatment Failure Embolization Retrospective Studies Hematoma business.industry Major trauma Head injury Hemodynamics 030208 emergency & critical care medicine medicine.disease Embolization Therapeutic United Kingdom Surgery Cross-Sectional Studies Radiological weapon Emergency Medicine Female Radiology business Spleen |
| Zdroj: | European Journal of Trauma and Emergency Surgery. 44:397-406 |
| ISSN: | 1863-9941 1863-9933 |
| DOI: | 10.1007/s00068-017-0807-5 |
| Popis: | To review the management of patients >16 years with blunt splenic injury in a single, UK, major trauma centre and identify whether the following are associated with success or failure of non-operative management with selective use of arterial embolization (NOM ± AE): age, Injury Severity Score (ISS), head injury, haemodynamic instability, massive transfusion, radiological hard signs [contrast extravasation or pseudoaneurysm on the initial computed tomography (CT) scan], grade, and presence of intraparenchymal haematoma or splenic laceration. Retrospective, cross-sectional study undertaken between April 2012 and October 2015. Paediatric patients, penetrating splenic trauma, and iatrogenic injuries were excluded. Follow-up was for at least 30 days. 154 patients were included. Median age was 38 years, 77.3% were male, and median ISS was 22. 14/87 (16.1%) patients re-bled following NOM in a median of 2.3 days (IQR 0.8–3.6 days). 8/28 (28.6%) patients re-bled following AE in a median of 2.0 days (IQR 1.3–3.7 days). Grade III–V injuries are a significant predictor of the failure of NOM ± AE (OR 15.6, 95% CI 3.1–78.9, p = 0.001). No grade I injuries and only 3.3% grade II injuries re-bled following NOM ± AE. Age ≥55 years, ISS, radiological hard signs, and haemodynamic instability are not significant predictors of the failure of NOM ± AE, but an intraparenchymal or subcapsular haematoma increases the likelihood of failure 11-fold (OR 10.9, 95% CI 2.2–55.1, p = 0.004). Higher grade injuries (III–V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM ± AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24 h with appropriate advice. |
| Databáze: | OpenAIRE |
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