Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study

2017 ◽  
Vol 44 (3) ◽  
pp. 397-406 ◽  
Author(s):  
Stella R. Smith ◽  
Louise Morris ◽  
Stephen Spreadborough ◽  
Waleed Al-Obaydi ◽  
Marta D’Auria ◽  
...  
Keyword(s):  
Major Trauma ◽  
Splenic Injury ◽  
Operative Management ◽  
Cross Sectional Study ◽  
Trauma Centre ◽  
Sectional Study ◽  
Cross Sectional ◽  
Blunt Splenic Injury ◽  
Major Trauma Centre ◽  
Non Operative Management

scholarly journals Proportion of Cases Managed Non-Operatively and Its Predictors for Failure in Splenic Injury – A Cross Sectional Study from VSSIMSAR, Odisha

2021 ◽  
Vol 8 (17) ◽  
pp. 1116-1121
Author(s):  
Harekrishna Majhi ◽  
Abinasha Mohapatra ◽  
Sachin Paul James ◽  
Ashok Kumar Nayak
Keyword(s):  
Blood Pressure ◽  
Splenic Injury ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
Haemodynamic Instability ◽  
Sectional Study ◽  
Cross Sectional ◽  
Non Operative Management

BACKGROUND The primary objective in the management of splenic injury earlier was to achieve early haemostasis which resulted in splenectomy as the treatment of choice. But after recognising the role of spleen in immune and haematopoietic functions, nonoperative management (NOM) was started. In order to practice non-operative management safely a better way to assess the severity of splenic injury was necessary. Eventually it became possible with the advent of computed tomography. Along with clinical assessment, it enabled us in the selection of appropriate patients for non-operative management. Now this modality is considered as the gold standard for patients who are hemodynamically stable or readily stabilisable. It decreases the duration of hospital stay and prevents postoperative morbidity. We wanted to find out the proportion of cases and predictors for failure of non-operative management among splenic injury patients in VIMSAR, Burla. METHODS This cross-sectional study was done among 35 patients with splenic injury who were hemodynamically stable from November 2018 to October 2020. RESULTS Age, sex, systolic blood pressure, diastolic blood pressure, mechanism of injury, Glasgow Coma Score (GCS), associated injury (if hemodynamically stable) were not found to be significant predictors in deciding the failure of non-operative management. CONCLUSIONS Most important predictor for failure of non-operative management was development of haemodynamic instability. Tachycardia, low mean arterial pressure (MAP), drop in haemoglobin (Hb) and haematocrit were significant parameters in our study and all these parameters ultimately point towards hemodynamic instability. KEYWORDS Non-Operative Management (Successful), Non-Operative Management (Failure), Hemodynamically Stable, Blunt Trauma Abdomen

Splenic artery embolisation in trauma: A five-year single-centre experience at a UK major trauma centre

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 280-287 ◽  
Author(s):  
James Davies ◽  
David Wells
Keyword(s):  
Splenic Artery ◽  
Major Trauma ◽  
Splenic Injury ◽  
Antimicrobial Prophylaxis ◽  
Operative Management ◽  
Research Network ◽  
Contrast Extravasation ◽  
Major Trauma Centre ◽  
Non Operative Management

Introduction Since the introduction of major trauma centres and regional trauma networks in 2012, management of splenic injury has shifted, with non-operative management now favoured. For those requiring intervention, splenic artery embolisation is well established as a first-line treatment in all but the most severely injured. Follow-up is variable, with few guidelines, highlighting the paucity of data addressing the need for further imaging and antimicrobial prophylaxis. This review was undertaken to assess practice and outcomes at our centre in the context of the contemporary literature. Methods This retrospective study captured splenic embolisations over five years (January 2012–December 2016). CRIS interventional radiology codes were used to retrieve embolisation cases and Trauma Audit and Research Network and hospital event statistics data were used to identify all cases of traumatic splenic injury and to identify splenectomy and non-operative management patients. Outcomes were compared with available standards from different sources. Results Over the study period 176 splenic injuries were identified, of which 122 underwent non-operative management, 28 were laparotomy first, and 26 undergoing embolisation with an increased trend to an ‘embolisation-first’ approach over this time. In the embolisation group, the age range was 16–79 yr (mean 41), 18 were male and the median time to intervention was 2 h 9 min (range 1.1–171 h), with eight following failed non-operative management. The proportion of proximal versus selective embolisation versus both was 10:14:1 and the predominant mechanism was coiling. One patient was not embolised due to absence of contrast extravasation on initial angiogram and two proceeded to splenectomy due to failure of splenic artery embolisation. There were complications in six patients: five ongoing left upper quadrant pain, one infected haematoma requiring drainage, two chest infections with pleural effusions, one of which required drainage. There were two deaths from other injuries. Fifteen of the 25 patients who underwent splenic artery embolisation had follow-up imaging, seven did not and three were excluded due to splenectomy and/or death; five patients were vaccinated according to the hospital splenectomy protocol, and six received prophylactic antibiotics. Conclusion Our data show that non-operative management is the mainstay of treatment for the majority of splenic injury patients. Serious complications are not common but variation does exist in follow-up. The changing management trends are in line with national data. These findings will help to further implement and develop local protocols but more work is required to address splenic function after embolisation and the requirement for antimicrobial prophylaxis.

scholarly journals 1553 Non-Operative Management of Acute Appendicitis at A Major Trauma Centre – A Retrospective Case Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S J K Chong ◽  
M Kaur ◽  
C Palmer ◽  
S Jaunoo
Keyword(s):  
Acute Appendicitis ◽  
Operative Treatment ◽  
Treatment Strategy ◽  
Major Trauma ◽  
Case Series ◽  
Operative Management ◽  
Trauma Centre ◽  
Retrospective Case ◽  
Major Trauma Centre ◽  
Non Operative Management

Abstract Aim The recent CODA trial concluded that appendicitis patients with confirmed faecolith are at higher risk of appendicectomy and complications than those without faecolith. A retrospective case series of patients undergoing non-operative management of appendicitis at a major trauma centre was conducted to determine the success of non-operative management, defined as lack of operative management within 30 and 90 days of diagnosis, and the impact of presence of faecolith on outcomes. Method All patients who received a working diagnosis of appendicitis over a 16-week period between March and June 2020 were identified and their electronic records interrogated for: preliminary and final diagnoses; imaging modality and result; operative or non-operative initial treatment strategy; final treatment strategy; and histopathology results where applicable. Patients who received an initial operative treatment strategy were excluded. Patients for whom appendicitis was not confirmed on either imaging or histopathology were excluded. Results 24 patients received an initial non-operative treatment strategy and were eligible for inclusion. 15 patients (62.5%) underwent successful non-operative management. The remaining 9 patients (37.5%) required operative management within 30 days. Presence of faecolith was confirmed in 9 patients (37.5%). 3 patients (33%) with presence of faecolith required operative management, while 3 patients (25%) without presence of faecolith required operative management. 1 patient with confirmed faecolith developed a large intra-abdominal abscess while undergoing a non-operative treatment strategy and subsequently required right hemicolectomy. Conclusions The majority of our eligible appendicitis patients were successfully managed non-operatively. Presence of faecolith in acute appendicitis is associated with increased risk of requiring operative management.

scholarly journals A cross-sectional study of knife injuries at a London major trauma centre

2014 ◽  
Vol 96 (1) ◽  
pp. 23-26 ◽  
Author(s):  
JR Pallett ◽  
E Sutherland ◽  
E Glucksman ◽  
M Tunnicliff ◽  
JW Keep
Keyword(s):  
Major Trauma ◽  
Case Fatality ◽  
Trauma Team ◽  
Cross Sectional Study ◽  
Trauma Centre ◽  
Mortality Data ◽  
Contributory Factor ◽  
Cross Sectional ◽  
Major Trauma Centre ◽  
Knife Injury

INTRODUCTION No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period. METHODS A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected. RESULTS A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team’s caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16–24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury. CONCLUSIONS Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED.

scholarly journals Non-operative management of blunt splenic injury.

BMJ ◽  
1991 ◽  
Vol 303 (6795) ◽  
pp. 188-188
Author(s):  
R Fitzgerald
Keyword(s):  
Splenic Injury ◽  
Operative Management ◽  
Blunt Splenic Injury ◽  
Non Operative Management

Selective Non-operative Management of Blunt Splenic Injury

2013 ◽  
Vol 3 (1) ◽  
pp. 29-31
Author(s):  
Seung Hwan Lee ◽  
Ji Young Jang ◽  
Hongjin Shim ◽  
Jae Gil Lee
Keyword(s):  
Splenic Injury ◽  
Operative Management ◽  
Blunt Splenic Injury ◽  
Non Operative Management
Sign in / Sign up

Export Citation Format

Share Document