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

Carvalho, Fábio Henrique de; Romeiro, Paula Christina Marra; Collaço, Iwan Augusto; Baretta, Giórgio Alfredo Pedroso; Freitas, Alexandre Coutinho Teixeira de; Matias, Jorge Eduardo Fouto

doi:10.1590/s0100-69912009000200006

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…Another study carried out in adults from our hospital, considered conservative treatment of splenic injuries grade IV to be safe, failing in only two patients (7.7%), that were operated due to worsening of abdominal pain and hypovolemic shock; there were no complications or deaths 22 . Another Brazilian study, concluded that ISS and grade of splenic injury have direct and significant relationship with the failure rate of the non-operative treatment, a relationship that was not confirmed in the present study 35 . The fact that in our service, the decision to operate does not take in account the grade of the injury, may help explain these discrepancies.…”

Section: Discussioncontrasting

confidence: 90%

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children

Cunha

FILHO

Miranda

et al. 2023

Rev. Col. Bras. Cir.

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Introduction: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. Methods: retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. Results: only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. Conclusion: the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.

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Section: Discussioncontrasting

confidence: 90%

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children

Cunha

FILHO

Miranda

et al. 2023

Rev. Col. Bras. Cir.

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“…Isolated lesions of the spleen have a good response to NOM, with up to 96.8% success rate 27 , 29 . However, the higher the injury’s degree, the greater the risk of failure, which can reach up to 75% for grade 5 lesions 13 , 23 . Larger splenic lesions (grade III or IV) may be conducted by NOM, but attention should be paid to the risk of late bleeding, as well as the need for endovascular embolization 32 .…”

Section: Discussionmentioning

confidence: 99%

Epidemiological profile of patients undergoing non-operative management of solid organ injury and associated factors with mortality

SARQUIS,

COLLAÇO,

TODERKE

et al. 2024

Rev. Col. Bras. Cir.

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Introduction: Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients. Methods: This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention. Results: A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention. Conclusion: The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.

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“…(24) hemodinamik yönden stabil durumda bulunan 87 tane karaciğer yaralanmalı hastada AST düzeyinin ortalama olarak 145.3±180.4 U/L, ALT düzeyinin ortalama olarak 84±119.8 U/L olduğunu raporlamışlardır. Künt karın travmalı olguların incelendiği başka bir çalışmada ise hastaneye başvuru anında hemoglobin seviyesinin ortalama 11.9±2.2 g/dL olduğu bildirilmiştir (25). Biz çalışmamızda karın travmalı olguların acil servise başvurduğundaki hemoglobin değerinin künt travmalar için ortalama 12.1 g/dL, penetran travmalar için ortalama 13.5 g/dL, beyaz küre sayısını künt travmalar için ortalama 13600 bin/dL, penetran travmalar için ise ortalama 12900 bin/dL olduğunu ve bu sonuçlarımızın literatür ile uyumlu olduğunu gördük.…”

Section: Discussionunclassified

The Evaluation of Demographic and Clinical Features of Isolated Abdominal Trauma

Acar¹,

Baydın²,

Yardan³

2012

JAEM

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Objective:We aimed to investigate the demographical features, clinical and laboratory findings, treatment, rates of mortality of patients above 16 years admitted to emergency department with isolated abdominal trauma and who contribute to our country's literature. Material and Methods: This study involves 106 adult patients admitted to the emergency service of our hospital with isolated abdominal trauma between January 2005 and 2009. Data collected from files were loaded to the SPSS 15.0 computer programme. For continuous data in comparison of groups, Mann-Whitney U test; and for discontinuous data Chi-Square test was performed. Results: 79% of abdominal trauma patients were male and median age was 31. The most frequent mechanism of injury was penetrating trauma. The most frequent etiology was motor vehicle accident. We determined that 76.4% of patients were admitted in the first 3 hours. The most common complaint was abdominal pain, and rebound was observed in 20.8% of cases. We observed that 22.6% of the patients were hypotensive and, of those hypotensive patients, 91.7% underwent surgery. 45.3% of cases had erythrocyte therapy replacement and those who had 2 units and more replacement requirement had a higher probability of undergoing surgery (p<0.05). Conclusion: The main cause of abdominal trauma is motor vehicle accidents and a systolic blood pressure less than 90 mmHg increases the possibility of surgical treatment. (JAEM 2012; 11: 216-22) Özet Amaç: İzole karın travması nedeniyle acil servise başvuran 16 yaş ve üzerindeki erişkin olguların; demografik özelliklerini, karın travmalarının klinik ve laboratuar bulgularını, tedavilerini, mortalite oranlarını incelemeyi ve bu konuda ülkemizdeki literatüre katkıda bulunmayı amaçladık. Gereç ve Yöntemler: Bu Çalışma Ocak 2005-2009 tarihleri arasında hastanemiz acil servisine izole karın travması nedeniyle başvuran erişkin 106 hastayı kapsamaktadır. Hastaların dosyalarından elde edilen veriler SPSS 15.0 bilgisayar programına yüklendi. Gruplar arasındaki karşılaştırmalarda sürekli veriler için Mann-Whitney U testi, kesikli veriler için ki kare testi uygulanmıştır. Bulgular: Karın travmalı olguların %79.2'si erkekti ve yaş ortancası 31 idi. Karın travması oluş mekanizması açısından incelendiğinde en sık penetran travmanın (%52.8), nedeni açısından bakıldığında ise en sık trafik kazalarının (%35.8) görüldüğü saptandı. Olguların %76.4'ünün ilk 3 saat içinde acil servise başvurduğu, başvuru anında en sık şikayetin karın ağrısı olduğu ve fizik muayenede olguların %20.8'inde rebound tespit edildiği görüldü. Olguların %22.6'nın hipotansif olduğu ve bu hipotansif hastaların %91.7'sinin cerrahi olarak tedavi edildiği görüldü. Olguların %45.3'üne eritrosit replasmanı yapılırken, 2 ünite ve üzerinde eritrosit replasmanı ihtiyacı olanların cerrahiye girme olasılığının arttığı gözlemlendi (p<0.05). Sonuç: Karın travmalarına en sık trafik kazaları neden olmakta ve hastaların acil servise başvuru anındaki sistolik kan basıncının 90 mmHg'dan düşük olması cerrahi tedavi olasılığı...

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

Cited by 6 publications

References 29 publications

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children

Epidemiological profile of patients undergoing non-operative management of solid organ injury and associated factors with mortality

The Evaluation of Demographic and Clinical Features of Isolated Abdominal Trauma

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