Critique of: Blunt splenic trauma: Splenectomy increases early infectious complications: A prospective multicenter study
| Autor: | Hassan Al Thani, Mazin Tuma, Rifat Latifi, Husham Abdul Rahman, Ammar Almadani |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Blood transfusion business.industry Incidence (epidemiology) medicine.medical_treatment Major trauma Splenectomy lcsh:Medical emergencies. Critical care. Intensive care. First aid lcsh:RC86-88.9 Critical Care and Intensive Care Medicine medicine.disease Blunt splenic trauma Surgery Blunt Laparotomy Emergency Medicine medicine Abscess business |
| Zdroj: | Journal of Emergency Medicine, Trauma and Acute Care, Vol 2012, Iss 1 (2012) |
| ISSN: | 1999-7094 1999-7086 |
| DOI: | 10.5339/jemtac.2012.17 |
| Popis: | COMMENTARY The study by Demetriades et al., evaluating the effect of different methods of splenic injury management on early infectious complications is both timely and offers new insight into the management of trauma patients. It addresses a common injury with a debatable management approach. This is a prospective, multicenter study performed over a 22-month period (March 2009–December 2010). All patients with blunt splenic injury admitted to three Level I trauma centers (two centers in USA and one in South Africa) were studied. Patients were categorized according to the final management of their splenic injury into two major groups: splenectomy or splenic preservation. Five outcome measures were evaluated; the development of early intra-abdominal abscess, wound infection, pneumonia, urinary tract infection, and septicemia. All were compared using standard statistical tools. The notable strength of this study is that the authors analyzed trauma populations from three major trauma centers in the USA and South Africa, which added to the validity of the results. However, the differences in clinical practice between the centers was not fully addressed. Firstly, the variation in antibiotic usage and whether this has affected the infection rate was not mentioned. The current recommendation is not to administer prophylactic antibiotics for a period longer than 24 h in critically injured patients. Secondly, the impact of blood transfusion is not discussed among the various centers. Blood transfusion is a significant risk factor and an independent predictor for the development of postoperative infections in surgical and trauma patients. In addition, the practice of damage control laparotomy was not elaborated on; those patients who need a damage control approach, especially with abdominal packing, are well known to have a higher incidence of postoperative infections. The spleen preservation group had a lower incidence of early infectious complications compared to the splenectomy group (5.2% versus 32%, p value , 0.001). The spleen preservation group included patients treated with laparotomy as well as those treated none operatively. The sub group analysis of patients who underwent laparotomy only showed that the splenorrhaphy group was small (19 patients), therefore we couldn’t draw a concrete conclusion regarding the impact of laparatomy on the infection rates, particularly the wound and intra-abdominal infections. In conclusion this study was well conducted, the data was extensively analyzed and adds a level II evidence to a debatable clinical approach in splenic injury management. We agree with the authors that all efforts should be directed toward preserving the spleen in trauma patients to minimize the risk of infection, provided that the patient is hemodynamically stable. |
| Databáze: | OpenAIRE |
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