scholarly journals Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Michel Teuben ◽  
Roy Spijkerman ◽  
Taco Blokhuis ◽  
Roman Pfeifer ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Mental Status ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Splenic Trauma ◽  
Blunt Splenic Injury ◽  
Icu Stay ◽  
Severity Scores ◽  
Gcs Score ◽  
The Impact

Abstract Background Treatment of blunt splenic injury has changed over the past decades. Nonoperative management (NOM) is the treatment of choice. Adequate patient selection is a prerequisite for successful NOM. Impaired mental status is considered as a relative contra indication for NOM. However, the impact of altered consciousness in well-equipped trauma institutes is unclear. We hypothesized that impaired mental status does not affect outcome in patients with splenic trauma. Methods Our prospectively composed trauma database was used and adult patients with blunt splenic injury were included during a 14-year time period. Treatment guidelines remained unaltered over time. Patients were grouped based on the presence (Group GCS: < 14) or absence (Group GCS: 14–15) of impaired mental status. Outcome was compared. Results A total of 161 patients were included, of whom 82 were selected for NOM. 36% of patients had a GCS-score < 14 (N = 20). The median GCS-score in patients with reduced consciousness was 9 (range 6–12). Groups were comparable except for significantly higher injury severity scores in the impaired mental status group (19 vs. 17, p = 0.007). Length of stay (28 vs. 9 days, p < 0.001) and ICU-stay (8 vs. 0 days, p = 0.005) were longer in patients with decreased GCS-scores. Failure of NOM, total splenectomy rates, complications and mortality did not differ between both study groups. Conclusion This study shows that NOM for blunt splenic trauma is a viable treatment modality in well-equipped institutions, regardless of the patients mental status. However, the presence of neurologic impairment is associated with prolonged ICU-stay and hospitalization. We recommend, in institutions with adequate monitoring facilities, to attempt nonoperative management for blunt splenic injury, in all hemodynamically stable patients without hollow organ injuries, also in the case of reduced consciousness.

Nonoperative Management of Blunt Splenic Trauma in the Elderly: Does Age Play a Role?

2007 ◽  
Vol 73 (6) ◽  
pp. 585-589 ◽  
Author(s):  
Kris Siriratsivawong ◽  
Mazen Zenati ◽  
Gregory A. Watson ◽  
Brian G. Harbrecht
Keyword(s):  
Older Patients ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Age Groups ◽  
Operative Management ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Splenic Trauma ◽  
Blunt Splenic Injury

Nonoperative management (NOM) of blunt splenic injury has become more frequent in the past several decades. Criteria that predict successful NOM remain poorly defined, and one factor that has been studied previously has been patient age. Previous studies have defined older patients as those greater than 55 years of age, but no studies have compared younger patients (55–75 years) with older patients (75+ years) within this age group. A total of 1008 patients ≥55 years of age who sustained blunt splenic injury between 1993 and 2001 were analyzed from the Pennsylvania Trauma Systems Foundation database. Statistical analysis was performed using regression analysis. Data was expressed as mean ± SD, and a P value of ≤ 0.05 was considered significant. Patients were classified as operative management (OM; 39.9%) or NOM (60.1%) according to their initial plan of treatment. Of the patients in the NOM group, 75.3 per cent were successfully managed nonoperatively (SNOM), whereas 24.7 per cent eventually required surgery. The Injury Severity Score of the OM group was highest (34) compared with the SNOM group (22) and failed NOM (FNOM; 27) groups. The mean splenic injury grade for OM, SNOM, and FNOM was 3.5, 2.4, and 3.3, respectively. The number of pre-existing conditions did not differ among the three groups. An upward trend in the failure rate of NOM was observed with increasing age (19.0%, 27.1%, and 28.3%, respectively) for three age groups, 55–64, 65–74, and 75+, but this trend was not statistically significant. Mortality rate was highest in the OM group (35.6%) compared with the successful (16.7%) and failed NOM (17.9%). Hospital length of stay (LOS) and intensive care unit (ICU) LOS were highest among patients who failed NOM (mean hospital LOS = 20.7 days, mean ICU LOS = 13.2 days) compared with OM (17.2 and 10.4, respectively) and successful NOM (12.4 and 6.9, respectively). The majority of patients ≥55 years with blunt splenic injuries can be managed nonoperatively when carefully selected. In the subset of patients older than 55 years of age, increasing age is associated with a trend toward higher failure rates. Mortality was high regardless of management, and failure of NOM in older patients is associated with significantly longer hospital and ICU LOS.

Does Splenic Embolization and Grade of Splenic Injury Impact Nonoperative Management in Patients Sustaining Blunt Splenic Trauma?

2011 ◽  
Vol 77 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Elan Jeremitsky ◽  
Amy Kao ◽  
Chad Carlton ◽  
Aurelio Rodriguez ◽  
Adrian Ong
Keyword(s):  
Splenic Injury ◽  
Nonoperative Management ◽  
Protective Measure ◽  
Splenic Trauma ◽  
Increased Risk ◽  
Splenic Embolization ◽  
Blunt Splenic Trauma ◽  
Injury Grade ◽  
The Impact ◽  
Grade Iii

Nonoperative management (NOM) for blunt splenic trauma (BST) is an established practice. The impact of splenic embolization (SE) in the algorithm for NOM has not been well studied. This study evaluates the role of SE and spleen injury grade on failure of NOM. Retrospective cohort of trauma registry over a 7-year period (2000-2006) for patients who suffered BST was studied. Data including demographics, splenic injury grade, and SE were recorded. Characteristics were compared between the successful and failed NOM groups. Kaplan-Meier, life table, and Cox-proportional hazard regression analyses were performed. Of the 499 patients who suffered BST, 407 (81.6%) patients had successful NOM and 92 (18.4%) patients failed NOM (including splenectomies performed within 1 hour of admission). Failed NOM group had a higher splenic injury grade compared with the successful NOM group ( P < 0.0001). Seventy-five per cent underwent a splenectomy within 7.7 hours of admission. Nearly all grade I and II splenic injuries that failed NOM occurred by 24 hours. Grade 3 and 4 injuries that failed NOM occurred by 150 hours. SE was protective against splenectomy (Hazard Ratio (HR) 0.18, 95% confidence interval: 0.06-0.55, P = 0.004), whereas splenic injury grades III or higher was associated with increased risk of splenectomy (grade III: HR 5.26, P = 0.003; grade IV: HR 6.84, P = 0.002; grade V: HR 9.81, P = 0.002) compared with those with splenic injury grade I. Splenic embolization is a protective measure to reduce the failure of NOM. Spleen injury grade III and higher was significantly associated with NOM failure and would require a 5-day inpatient observation.

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

2014 ◽  
Vol 80 (11) ◽  
pp. 1159-1163 ◽  
Author(s):  
Vincent P. Duron ◽  
Kristopher M. Day ◽  
Shaun A. Steigman ◽  
Jeremy T. Aidlen ◽  
Francois I. Luks
Keyword(s):  
Blood Transfusion ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Vital Signs ◽  
Transfusion Rate ◽  
Blunt Splenic Injury ◽  
Pediatric Hospitals ◽  
Revised Trauma Score ◽  
Trauma Score

Nonoperative management of hemodynamically stable blunt splenic injury (BSI) is the gold standard in children. Recent studies from nonpediatric surgery-specialized trauma centers have demonstrated a rise in transfusion and angioembolization associated with decreased splenectomy rates. We investigate the rate of splenectomy and nonsurgical interventions (angioembolization, blood transfusion) for BSI in a pediatric surgery-specialized trauma center. We conducted a retrospective review of children (0 to 18 years) treated between September 2001 and September 2011 at a children's hospital. Analyzed data included presenting vital signs, nadir hemoglobin, splenic injury grade, Revised Trauma Score, and Injury Severity Score (ISS). Measured outcomes included transfusion, angioembolization, and splenectomy rates. The study period was divided into three time periods to identify possible trends and compared with national averages. There were 180 patients, 91 with multiple injuries (50.6%) and 89 (49.4%) with isolated BSI. Seventy-six per cent of patients were male, average age was 12.8 years, and average ISS was 14.7. The overall splenectomy rate was 1.7 per cent (1.1% for isolated splenic injury). Our angioembolization rate was 0.6 per cent compared with 7.4 to 16 per cent nationally. Our transfusion rate was 14.4 per cent overall and 5.6 per cent for isolated splenic injury compared with 9.5 to 24.9 per cent nationally. Intervention rates remained unchanged over the study period. Splenectomy rates have remained low at our institution without an increase in angioembolization or transfusion. Children with splenic injuries treated at dedicated pediatric hospitals can be successfully managed nonoperatively without angioembolization or blood transfusion.

Early Selective Angioembolization Improves Success of Nonoperative Management of Blunt Splenic Injury

2007 ◽  
Vol 73 (9) ◽  
pp. 897-902 ◽  
Author(s):  
Shih-Chi Wu ◽  
Kuan-Chih Chow ◽  
Kun-Hua Lee ◽  
Cheng-Cheng Tung ◽  
Albert D. Yang ◽  
...  
Keyword(s):  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Ct Scans ◽  
Trauma Patients ◽  
Abdominal Ct ◽  
Contrast Extravasation ◽  
Splenic Artery Embolization ◽  
Group B ◽  
The Impact

The role of angioembolization in the management of patients with blunt spleen injury is still under debate. Our study examined the impact of splenic artery embolization (SAE) on the outcome of such patients. We reviewed 114 consecutive blunt abdominal trauma patients with isolated splenic injury over a period of 40 months, including 61 patients seen before (Group A) and 53 patients seen after (Group B) the adoption of SAE. Hemodynamically unstable patients underwent the abdominal exploration and stable patients were evaluated with CT scans of abdomen and pelvis. Patients underwent SAE based on the findings of CT scans, including contrast extravasation or large hemoperitoneum. For initially stable patients, there were no differences in nonoperative management success rate between Groups A and B in regards to injury severity score ≥16, age, or grades of splenic injury ≥3. In comparison, among patients with large hemo-peritoneum found by abdominal CT, Group B had significantly better nonoperative management success rates (P < 0.05). SAE was successful to control bleeding in 80 per cent of patients. Partial splenic infarction was noted in all patients after the procedure but it resolved by six months. By using criteria developed based on abdominal CT scans for angioembolization, we are able to improve nonoperative splenic salvage rate.

Outcomes of Nonoperative Management of Blunt Splenic Injury—Asian Experience

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1281-1286 ◽  
Author(s):  
Vishal G. Shelat ◽  
Tan Ek Khoon ◽  
Teo Li Tserng ◽  
Vijayan Appasamy ◽  
Chiu Ming Terk
Keyword(s):  
Splenic Artery ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Outcome Data ◽  
Median Hospital Stay ◽  
Blunt Splenic Injury ◽  
Grade Ii ◽  
Splenic Salvage ◽  
Salvage Rate

Management of blunt splenic injury (BSI) has evolved with a focus on nonoperative management (NOM) and spleen preservation. Factors predictive of failure of NOM are yet ill defined. We report our experience of outcomes of NOM of BSI and evaluate factors that predict failure. This is a retrospective study from a prospective trauma registry of a university-affiliated major trauma center over a 4 ½-year period. All the patients admitted with BSI from January 2004 to May 2009 were included in this study. Demographic, clinical, operative, and outcome data were studied. Forty-five patients (51.1%) with a mean age of 38 years (range, 16–77 years) were admitted for NOM. The majority of patients was male (88.9%). Mean Injury Severity Score (ISS) was 25.2 ± 12.7 and the majority of the patients (42.2%) had Grade II BSI. Three patients (6.7%) underwent splenic artery angioembolization. Three patients (6.7%) failed NOM and required splenectomy. The overall splenic salvage rate was 93.3%. The median hospital stay was 7 days (range, 2–66 days) and there was no mortality. Lower hemoglobin on admission (15.9 versus 10.1 g/dL, P = 0.006), hematocrit &lt;30.0% on admission (P = 0.04), higher ISS (39.3 versus 24.2, P = 0.04) and Grade V injury (P = 0.003) predicted failure of NOM. NOM for BSI is safe, feasible, and it increases splenic salvage. Splenic artery angioembolization is a useful adjunct. Low hemoglobin, hematocrit &lt;30%, high ISS, and grade V splenic injury predicts failure of NOM. Grade V splenic injury should be considered for routine angioembolization if NOM is contemplated.

scholarly journals Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

2021 ◽  
Vol 38 (01) ◽  
pp. 105-112
Author(s):  
Majd Habash ◽  
Darrel Ceballos ◽  
Andrew J. Gunn
Keyword(s):  
Clinical Outcomes ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Artery Embolization ◽  
Splenic Artery Embolization

AbstractThe spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.

Splenic Trauma

1980 ◽  
Vol 1 (7) ◽  
pp. 203-206
Author(s):  
Sara H. Sinal
Keyword(s):  
Conservative Management ◽  
Pneumococcal Vaccine ◽  
Splenic Injury ◽  
Surgical Repair ◽  
Nonoperative Management ◽  
Life Time ◽  
Modern Technology ◽  
Accurate Diagnosis ◽  
Splenic Trauma

Modern technology, specifically the splenic scan, aids in a quick and accurate diagnosis of splenic injury. Because children rarely exsanguinate from trauma to the spleen, splenectomy has been replaced by more conservative management as the treatment of choice in splenic trauma. Both nonoperative management and surgical repair of the spleen are alternatives. If splenectomy is necessary, the child is at greatly increased life time risk for an episode of overwhelming sepsis. Pneumococcal vaccine is indicated in children who must undergo splenectomy.

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