Safety of selective nonoperative management for blunt splenic trauma: the impact of concomitant injuries

Michel Paul Johan Teuben*, Roy Spijkerman, Taco Johan Blokhuis, Roman Pfeifer, Henrik Teuber, Hans-Christoph Pape, Luke Petrus Hendrikus Leenen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Web of Science)

Abstract

BackgroundNonoperative management for blunt splenic injury is the preferred treatment. To improve the outcome of selective nonoperative therapy, the current challenge is to identify factors that predict failure. Little is known about the impact of concomitant injury on outcome. Our study has two goals. First, to determine whether concomitant injury affects the safety of selective nonoperative treatment. Secondly we aimed to identify factors that can predict failure.MethodsFrom our prospective trauma registry we selected all nonoperatively treated adult patients with blunt splenic trauma admitted between 01.01.2000 and 12.21.2013. All concurrent injuries with an AIS2 were scored. We grouped and compared patients sustaining solitary splenic injuries and patients with concomitant injuries. To identify specific factors that predict failure we used a multivariable regression analysis.ResultsA total of 79 patients were included. Failure of nonoperative therapy (n=11) and complications only occurred in patients sustaining concomitant injury. Furthermore, ICU-stay as well as hospitalization time were significantly prolonged in the presence of associated injury (4 versus 13days,p<0.05). Mortality was not seen. Multivariable analysis revealed the presence of a femur fracture and higher age as predictors of failure.ConclusionsNonoperative management for hemodynamically normal patients with blunt splenic injury is feasible and safe, even in the presence of concurrent (non-hollow organ) injuries or a contrast blush on CT. However, associated injuries are related to prolonged intensive care unit- and hospital stay, complications, and failure of nonoperative management. Specifically, higher age and the presence of a femur fracture are predictors of failure.
Original languageEnglish
Article number32
Number of pages8
JournalPatient Safety in Surgery
Volume12
DOIs
Publication statusPublished - 27 Nov 2018

Keywords

  • Blunt splenic injury
  • Abdominal trauma
  • Nonoperative management
  • Concurrent injuries
  • HOLLOW VISCUS INJURY
  • SOLID-ORGAN INJURY
  • ADULTS
  • FAILURE
  • EMBOLIZATION
  • MULTICENTER
  • LIVER
  • SCORE
  • AGE

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