scholarly journals Failure Risk Factor For Non-Operative Treatment of Splenic Trauma

2020 ◽  
Author(s):  
Alexandre Maubert ◽  
Jonathan Douissard ◽  
Pierre-Alain Tokoto ◽  
Damien Massalou
Keyword(s):  
Statistical Significance ◽  
Operative Management ◽  
University Hospital ◽  
Splenic Trauma ◽  
Level Of Evidence ◽  
Failure Group ◽  
The Hours ◽  
Successful Group ◽  
Grade 3 ◽  
Non Operative Management

Abstract Background: Splenic trauma is a common pattern for admission in blunt abdominal trauma. The objective of this study is to identify risk factors for failure of non-operative management (NOM) in splenic trauma.Methods: This is a retrospective monocentric analysis of a prospectively collected database. All patients admitted in the university hospital of Nice [Centre Hospitalier Universitaire (CHU) de Nice, France] for a splenic trauma from January 1st 2006 to January 6th 2018 were included. Primary outcome was the need for delayed splenectomy as an indicator of NOM failure.Results: Two-hundred-eighty patients were included in this study. Most splenic lesions were severe grades (grade 3 or higher). In total, 83 splenectomies were performed urgently, i.e. 29% of patients; 88 angio-embolizations, i.e., 31% of patients with a success rate greater than 80%; 14.7% of 136 patients who had no previous angio-embolization required secondary splenectomy; 19.7% of the 61 patients who had anterior angio-embolization required secondary splenectomy. Age was not found associated with a higher failure rate (44 years in successful embolization vs 37.5 years in NOM-failure group, p = 0.15). Higher drop in hemoglobin levels between admission and 6 hours after admission was detected in the embolization failure group (-1.44 g/dl) as compared with the successful group (-0.68 g/dl), which approached statistical significance (p = 0.064).Conclusions: Hemoglobin monitoring in the hours following the admission of a patient with splenic trauma might be an important factor during the medical supervision of hemodynamically stable patients. Early identification of patients at high risk of NOM failure by hemoglobin monitoring may prevent late splenectomy.Level of evidence: IV (retrospective study)

scholarly journals Non operative management of isolated traumatic splenic injury

2021 ◽  
Vol 8 (4) ◽  
pp. 1101
Author(s):  
Shiwani Thakur ◽  
Naseer Ahmed Awan ◽  
Umer Mushtaq ◽  
Shaukat Jeelani ◽  
M. R. Attri ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Splenic Injury ◽  
Statistical Significance ◽  
Operative Management ◽  
Successful Outcome ◽  
Blunt Injury ◽  
P Value ◽  
Splenic Trauma ◽  
High Dependency ◽  
Non Operative Management

Background: Road traffic accidents, sports injuries, assaults, and falls from height, are among most common causes of blunt splenic trauma. In 1970s, postsplenectomy complications were published by some authors, revealing the high mortality and morbidity related to overwhelming postsplenectomy infection (OPSI). Therefore, conservative management for splenic trauma was accepted as treatment of choice in all the patients to decrease mortality due to OPSI. Therefore, NOM of traumatic splenic injury has now been accepted as standard treatment of choice for all AAST grade I, II and III, whereas this was not found safe in higher grades of splenic trauma.  Methods: This is a hospital based prospective observational study, done on 45 hemodynamically stable patients of splenic trauma. Results: Out of all studied parameters grade of injury, contrast blush on CT scan, grade of hemoperitoneum showed statistical significance with p value<0.001, however gender, age, mode of injury, showed no statistical significance. In our study, out of 45 patients, 38 (84.44%) patients had successful NOM of splenic trauma.  Conclusions: Non-operative management (NOM) of blunt injury to the spleen in adults has become the standard of care in hemodynamically stable patients. This modality of treatment in paediatric patients is also highly successful and is standard treatment of choice in both adults and children. Success of NOM of isolated splenic injury depends on multiple factors such as availability of ICUs, high dependency units for strict monitoring, blood banks and availability of multidisciplinary team efforts encompassing anesthetics, trauma surgeons, radiologists, for successful outcome. 

The non-operative management of bony mallet injuries

2021 ◽  
pp. 175319342199298
Author(s):  
Ryan W. Trickett ◽  
James Brock ◽  
David J. Shewring
Keyword(s):  
Fragment Size ◽  
Visual Analogue Score ◽  
Operative Management ◽  
Clinical Results ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Custom Made ◽  
Evaluation Measure ◽  
Non Operative Management ◽  
Extensor Lag

Over a 4-year period, 218 mallet fractures in 211 adult patients were treated using a custom-made thermoplastic splint. Clinical results were collected prospectively, including the visual analogue score for pain, the range of motion and extensor lag, and the Patient Evaluation Measure (PEM). The joints were congruent in 168 and subluxed in 50. There were no differences in range of movement, extensor lag or PEM associated with articular subluxation or the size of the articular fragment. Pre-existing joint degeneration did not influence outcome. Non-surgical treatment demonstrates predictably good outcomes regardless of fragment size or subluxation in most patients and should be considered when discussing treatment for patients with bony mallet fractures. Level of evidence: III

Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa

2020 ◽  
Vol 44 (5) ◽  
pp. 1485-1491
Author(s):  
Matthew C. Hernandez ◽  
Michael D. Traynor ◽  
Ariel W. Knight ◽  
Victor Y. Kong ◽  
Grant L. Laing ◽  
...  
Keyword(s):  
South Africa ◽  
Operative Management ◽  
Splenic Trauma ◽  
Non Operative Management

scholarly journals Non-operative Management of Blunt abdominal trauma in a Tertiary Care Hospital of Nepal

2013 ◽  
Vol 2 (1) ◽  
pp. 38-41 ◽  
Author(s):  
P Ghimire ◽  
N Yogi ◽  
P Ghimire
Keyword(s):  
Teaching Hospital ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Operative Management ◽  
Bowel Injury ◽  
Care Hospital ◽  
Failure Group ◽  
Management Group ◽  
Clinical Instability ◽  
Non Operative Management

Background: To assess the feasibility of Non-operative management of Blunt abdominal trauma in a teaching hospital of Nepal. Methods: A prospective observational study was carried out over a period of 3 years including 52 cases of blunt abdominal trauma in a teaching hospital in western part of Nepal. Patient and trauma characteristics of the cases, different modalities of treatment and outcomes were evaluated. All the cases were divided in 3 groups: Operative group, Non-Operative Management and Non-Operative Failure group. Operative group and non-operative management group were compared using Fischer Exact Test for categorical variable and student’s “t” test for continuous variable. Results: There were 36% of cases in operative group, 61% in non-operative management group and 2% in non-operative management failure group. Non-operative management was successful in 97% of cases. Injury severity score, admission hematocrit and hemodynamic status were significantly different between non-operative management and Operative group. Non-operative management failure occurred in 1 case and was secondary to delayed hepatic hemorrhage. Conclusion: Non-operative management of Blunt abdominal trauma can be attempted with high degree of success. Hemodynamic and clinical instability rather than severity of the organ injury is the predictor of failure in non-operative management. Spleen and bowel injury are the most common organ that usually land up in operative group because of hemodynamic instability in splenic injury and peritoneal contamination in bowel injury. Close surveillance in an intensive care unit is always desirable. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 38-41 DOI: http://dx.doi.org/10.3126/njms.v2i1.7650

scholarly journals The role of grade of injury in non-operative management of blunt hepatic and splenic trauma

Medicine ◽  
2019 ◽  
Vol 98 (35) ◽  
pp. e16746 ◽  
Author(s):  
Paolo Ruscelli ◽  
Alessandro Gemini ◽  
Massimiliano Rimini ◽  
Sergio Santella ◽  
Roberto Candelari ◽  
...  
Keyword(s):  
Operative Management ◽  
Splenic Trauma ◽  
Non Operative Management

scholarly journals Non-Operative Management for Renal and Splenic Trauma – A Case Report

2020 ◽  
Vol 13 (62) (2) ◽  
pp. 43-52
Author(s):  
Alexandru Georgian Lăculiceanu ◽  
Denis Anamaria Mereț ◽  
Ruxandra Rotaru ◽  
Mircea Daniel Hogea ◽  
Ioan Scârneciu
Keyword(s):  
Injury Severity ◽  
Left Kidney ◽  
Operative Management ◽  
Renal Trauma ◽  
Iliopsoas Muscle ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Grade Ii ◽  
Non Operative Management

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma  is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

Sign in / Sign up

Export Citation Format

Share Document