Blunt Splenic Injuries: High Nonoperative Management Rate Can Be Achieved with Selective Embolization

Dent, Daniel L.; Alsabrook, Grady; Erickson, Brian; Myers, John G.; Wholey, Michael H.; Stewart, Ronald M.; Root, Harlan D; Ferral, Héctor; Postoak, Darren; Napier, Dacia H.; Pruitt, Basil A.

doi:10.1097/01.ta.0000123037.66867.f2

Cited by 172 publications

(138 citation statements)

References 13 publications

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“…Only 9.8% of patients in NOM and 8% in SAE, had a secondary splenectomy despite a high median ISS at 18.5 and the absence of a clearly defined protocol. This could argue in favor of SAE which seems to be more effective in cases of high-grade spleen injury, large hemoperitoneum, or associated vascular lesions (2,(6)(7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Frandon¹,

Rodière²,

Arvieux³

et al. 2015

Diagn Interv Radiol

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B lunt splenic injury (BSI) has become more frequently managed nonoperatively over the years, with the results improved by the contribution of embolization, making it possible to treat active hemorrhages as well as prevent hemorrhages in high-grade trauma of the spleen without active bleeding (1-10). Three methods of splenic artery injury management can be defined: operative management (OM), nonoperative management (NOM), and nonoperative management with splenic artery embolization (SAE).The complication rate in relation to different management methods (operative and nonoperative) continues to be debated. The description and prevalence of these complications varies greatly from one series to another (7,(11)(12)(13), resulting from the confusion existing between adverse events related to injury and those related to treatment. The severity of polytrauma is taken into account using the patients' injury severity score (ISS), and several studies have shown that a high ISS was related to more nonsurgical treatment failures (14). Certain authors have taken a specific interest in the parameters of multiple injuries and shown that lesions of associated organs (pancreas, spinal cord, limbs) were related to more complications (15-17). The severity of trauma and associated lesions could therefore be considered confounding factors resulting in treatment failure and complications. A better understanding of these complications could help in preventing them.The objectives of this study were to compare outcomes of the three types of BSI management, determine if there are any complications statistically related to management methods, and demonstrate risk factors taking polytrauma into account. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTSThe total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSIONPatients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

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Section: Discussionmentioning

confidence: 99%

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Frandon¹,

Rodière²,

Arvieux³

et al. 2015

Diagn Interv Radiol

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“…O TNO das lesões esplênicas em trauma abdominal fechado obtém sucesso na maioria das séries atuais publicadas, com taxas de falha que variam de 2% a 33% 6,7 .…”

Section: Discussão Discussão Discussão Discussão Discussãounclassified

Fatores prognósticos relacionados à falha do tratamento não-operatório de lesões esplênicas no trauma abdominal fechado

Carvalho

Romeiro²,

Collaço³

et al. 2009

Rev. Col. Bras. Cir.

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Fatores prognósticos relacionados à falha do tratamento não-Fatores prognósticos relacionados à falha do tratamento não-Fatores prognósticos relacionados à falha do tratamento não-Fatores prognósticos relacionados à falha do tratamento não-Fatores prognósticos relacionados à falha do tratamento não-operatório de lesões esplênicas no trauma abdominal fechado operatório de lesões esplênicas no trauma abdominal fechado operatório de lesões esplênicas no trauma abdominal fechado operatório de lesões esplênicas no trauma abdominal fechado operatório de lesões esplênicas no trauma abdominal fechado Prognostic factors related to non surgical treatment failure of splenic injuries in Prognostic factors related to non surgical treatment failure of splenic injuries in Prognostic factors related to non surgical treatment failure of splenic injuries in Prognostic factors related to non surgical treatment failure of splenic injuries in Prognostic factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma the abdominal blunt trauma the abdominal blunt trauma the abdominal blunt trauma the abdominal blunt trauma FÁBIO Métodos: Métodos: Análise prospectiva de 56 pacientes adultos submetidos à TNO e divididos em um grupo de sucesso e outro de falha, que foi definida como necessidade de laparotomia por qualquer indicação. As lesões foram diagnosticadas por tomografia computadorizada e classificadas de acordo com os critérios da AAST (American Association for Surgery of Trauma). Os parâmetros estudados foram: na admissão -pressão arterial sistólica, frequências cardíaca e respiratória, nível de consciência (Escala de Glasgow) e RTS (Revised Trauma Score); durante a hospitalização -presença de lesões associadas, transfusão sanguínea e parâmetros hematológicos, tempo de internação e ISS (Injury Severity Score). Resultados Resultados Resultados Resultados Resultados: As falhas do TNO (19,6%) foram devidas à dor abdominal (45,4%), instabilidade hemodinâmica (36,4%), queda do volume globular associada a hematoma esplênico (9,1%) e abscesso esplênico (9,1%). Não foram observadas diferenças entre os grupos de sucesso e de falha nos dados na admissão. A taxa de falha de acordo com o grau da lesão esplênica foi 0% nos graus I e II agrupados; 17,5% nos graus III e IV agrupados e 80% no grau V (p = 0,0008). O uso de hemoderivados foi maior e mais frequente no grupo de falha (p=0,05). As relação do ISS (Injury Severity Score) com as taxas de falha foram 0% nos pacientes com ISS = 8; 15,9% nos com ISS entre 9 e 25, e 50% nos com ISS = 26 (p = 0,05 A s lesões esplênicas decorrentes de trauma abdominal fechado foram tratadas quase que exclusivamente por laparotomia e esplenectomia na primeira metade do sécu-lo passado. Essa conduta baseava-se nos bons resultados obtidos com a operação e na crença de que a remoção do baço não trazia consequências significativas para os pacientes, uma vez que a primeira evidência clínica favorecendo a preservação esplênica surgiu com a descrição da infecção fulminante pós...

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“…Splenic artery embolisation (SAE) has been shown to increase the rate of splenic conservation following trauma, [1][2][3][4][5][6] and is frequently performed as an adjunct to nonoperative management of blunt splenic injury which is now the standard of care in haemodynamically stable patients [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Foley

Kavnoudias

Cameron

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Materials and Methods Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Results Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. Conclusion IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

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Blunt Splenic Injuries: High Nonoperative Management Rate Can Be Achieved with Selective Embolization

Abstract: A high rate of NOM can be achieved with observation and selective use of arteriography with or without embolization in the management of blunt splenic injuries.

Cited by 172 publications

References 13 publications

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Fatores prognósticos relacionados à falha do tratamento não-operatório de lesões esplênicas no trauma abdominal fechado

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

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