TY - JOUR
T1 - Safety of selective nonoperative management for blunt splenic trauma
T2 - the impact of concomitant injuries
AU - Teuben, Michel Paul Johan
AU - Spijkerman, Roy
AU - Blokhuis, Taco Johan
AU - Pfeifer, Roman
AU - Teuber, Henrik
AU - Pape, Hans-Christoph
AU - Leenen, Luke Petrus Hendrikus
PY - 2018/11/27
Y1 - 2018/11/27
N2 - 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.
AB - 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.
KW - Blunt splenic injury
KW - Abdominal trauma
KW - Nonoperative management
KW - Concurrent injuries
KW - HOLLOW VISCUS INJURY
KW - SOLID-ORGAN INJURY
KW - ADULTS
KW - FAILURE
KW - EMBOLIZATION
KW - MULTICENTER
KW - LIVER
KW - SCORE
KW - AGE
U2 - 10.1186/s13037-018-0179-8
DO - 10.1186/s13037-018-0179-8
M3 - Article
C2 - 30505349
SN - 1754-9493
VL - 12
JO - Patient Safety in Surgery
JF - Patient Safety in Surgery
M1 - 32
ER -