Evidence-Based Management and Controversies in Blunt Splenic Trauma

Olthof, Dominique C.; Vlies, C. H. van der; Goslings, J. C.

doi:10.1007/s40719-017-0074-2

Cited by 40 publications

(29 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nonoperative management of splenic injuries has gradually become the standard of therapy in patients who are haemodynamically stable. 4,5 Currently, three methods of treatment of splenic trauma patients are followed: conservation (with or without angiography and embolisation), spleen-preserving operations and splenectomy. 6…”

Section: Introductionmentioning

confidence: 99%

Splenic trauma in the twenty-first century: changing trends in management

Roy

Mukherjee

Parik

2018

annals

View full text Add to dashboard Cite

Over the past three decades, management of blunt splenic trauma has changed radically. Use of improved diagnostic techniques and proper understanding of disease pathology has led to nonoperative management being chosen as the standard of care in patients who are haemodynamically stable. This review was undertaken to assess available literature regarding changing trends of management of blunt splenic trauma, and to identify the existing lacunae in nonoperative management. The PubMed database was searched for studies published between January 1987 and August 2017, using the keywords 'blunt splenic trauma' and 'nonoperative management'. One hundred and fifty-three articles were reviewed, of which 82 free full texts and free abstracts were used in the current review. There is clear evidence in published literature of the greater success of nonoperative over operative management in patients who are haemodynamically stable and the increasing utility of adjunctive therapies like angiography with embolisation. However, the review revealed a lack of universal guidelines for patient selection criteria and diagnostic and grading procedures needed for nonoperative management. Indications for splenic artery embolisation, the current role of splenectomy and spleen-preserving surgeries, together with the place of minimal access surgery in blunt splenic trauma remain grey areas. Moreover, parameters affecting the outcomes of nonoperative management and its failure and management need to be defined. This shows a need for future studies focused on these shortcomings with the ultimate aim being the formulation and implementation of universally accepted guidelines for safe and efficient management of blunt splenic trauma.

show abstract

Section: Introductionmentioning

confidence: 99%

Splenic trauma in the twenty-first century: changing trends in management

Roy

Mukherjee

Parik

2018

annals

View full text Add to dashboard Cite

show abstract

“…[1] The true value of splenic artery embolization remains a point of contention but generally, it is believed to increase the rate of splenic salvage. [2] Embolisation is not without complications: haemorrhage, abscess, infarction, renal failure, migration of coils and local access site complications such as infection, thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of a traumatic splenic artery pseudoaneurysm in an initially normal spleen: Case study and review of literature

Dollie

2018

CSS

View full text Add to dashboard Cite

Background: Blunt injury of the spleen is common and with the shift towards nonoperative management in haemodynamically stable patients, the delayed development of splenic artery pseudoaneurysms are of great concern. Management traditionally involves angioembolisation with the intent to preserve splenic function; however recent studies suggest that this is not without complication. Case presentation: We present a rare case of delayed splenic pseudoaneurysm arising 6 days post motorbike accident, with initial computerised tomography showing no evidence of splenic injury. The patient was successfully embolised and progressed well without complication. No clear cause was found for his development of splenic injury. Conclusions: Splenic artery pseudoaneurysms are not uncommon and necessitate follow-up imaging after nonoperative management of blunt splenic trauma. Once diagnosed, embolisation versus conservative management can be considered on a case-by-case basis.

show abstract

“…High level evidence for management of splenic injury is limited [ 5 ], and guidelines necessarily rely on studies with less than optimal design [ 6 ]. The American Association for the Surgery of Trauma (AAST) grading (herein referred upon as grade) and the presence of contrast extravasation on computed tomography (CT) (henceforth referred upon as blush) play an important role in planning the management of splenic injuries.…”

Section: Introductionmentioning

confidence: 99%

Grade III blunt splenic injury without contrast extravasation - World Society of Emergency Surgery Nijmegen consensus practice

et al. 2020

View full text Add to dashboard Cite

Background: Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Nevertheless, such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach. Methods: A questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES). This was delivered and answered live by acute care surgeons attending the 6 th WSES congress in Nijmegen in 2019. A dedicated mobile phone application was utilized to collect the answers. All answers were evaluated for areas of discrepancy with an 80% threshold for consensus between respondents. Results: Three factors generated discrepancy in opinion for managing this pattern of injury: the patients' injury severity, the presence of a bleeding diathesis, and an associated intra-abdominal injury. Agreement was obtained for the other eight factors. Conclusion: Researchers should focus their efforts on the identified area of discrepancy. Clinicians should use additional care in the presence of the three factors for which discordant opinions were found.

show abstract

Evidence-Based Management and Controversies in Blunt Splenic Trauma

Cited by 40 publications

References 37 publications

Splenic trauma in the twenty-first century: changing trends in management

Splenic trauma in the twenty-first century: changing trends in management

Delayed presentation of a traumatic splenic artery pseudoaneurysm in an initially normal spleen: Case study and review of literature

Grade III blunt splenic injury without contrast extravasation - World Society of Emergency Surgery Nijmegen consensus practice

Contact Info

Product

Resources

About