Management of the Most Severely Injured Spleen

Velmahos, George C.

doi:10.1001/archsurg.2010.58

Cited by 97 publications

(37 citation statements)

References 21 publications

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“…Consequently, most patients will respond to non-operative treatment. Our personal results support the principle of conservative treatment in all haemodynamically stable patients, with overall efficacy rate more than 91%, as was reported in modern literature (7,8).…”

Section: Discussionsupporting

confidence: 90%

Blunt Trauma in Pediatric Patients- Experience from Small Center

et al. 2015

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Section: Discussionsupporting

confidence: 90%

Blunt Trauma in Pediatric Patients- Experience from Small Center

et al. 2015

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“…and Wahl et al [10,21] treated HDS patients with NOM and hemodynamically unstable patients with OM. Blood pressure values were reported only in 10 studies [9-11,13,17,18,20-22,24], seven studies [9,10,16,18,20,22,24] reported the median systolic blood pressure, two studies [11,13] reported the number of patients with blood pressure above or below 90 mmHg and one study [21] reported the mean systolic/diastolic blood pressure. One study did not specify blood pressure criteria for NOM or OM [9].…”

Section: Methodsmentioning

confidence: 99%

“…ISS was reported in 19 studies: mean value was reported in 3 studies [8,12,19], median value ± SD in 14 studies [1,6,7,9,10,14,16-18,20,22-25], the range of ISS was reported in 1 study [11], while in another study [13] ISS was defined with values above or below a cut-off of 25. It was possible to extrapolate the ISS value for the patients in the two compared groups (NOM vs .…”

Section: Methodsmentioning

confidence: 99%

“…AAST grades of splenic lesions were reported in 11 studies: the number of patients relative to each AAST was reported in 6 studies [14,18,20-22], the mean AAST of NOM and OM groups were reported in 5 studies [6,10,16,23,24], and percentage of patients relative to AAST was reported in 1 study [25] (Additional file 3: Table S3).…”

Section: Methodsmentioning

confidence: 99%

“…Thirteen studies reported a specific diagnostic algorithm for abdominal trauma management [1,10,11,13-18,21,23-25], while five studies [7,9,12,19,22] did not (Additional file 4: Table S4).…”

Section: Methodsmentioning

confidence: 99%

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Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

et al. 2013

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IntroductionThe goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay.MethodsFor this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST.ResultsWe identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison.ConclusionsNOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.

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Successful Nonoperative Management of the Most Severe Blunt Liver Injuries

Wilden

Velmahos²,

Emhoff³

et al. 2012

Arch Surg

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Main Outcome Measure: Failure of NOM (f-NOM), defined as the need for a delayed operation.Results: One hundred thirty-one patients (33.3%) were operated on immediately, typically because of hemodynamic instability. Among 262 patients (66.7%) who were offered a trial of NOM, treatment failed in 23 patients (8.8%) (attributed to the liver in 17, with recurrent liver bleeding in 7 patients and biliary peritonitis in 10 patients). Multivariate analysis identified the following 2 independent predictors of f-NOM: systolic blood pressure on admission of 100 mm Hg or less and the presence of other abdominal organ injury. Failure of NOM was observed in 23% of patients with both independent predictors and in 4% of those with neither of the 2 independent predictors. No patients in the f-NOM group experienced life-threatening events because of f-NOM, and mortality was similar between patients with successful NOM (5.4%) and patients with f-NOM (8.7%) (P=.52). Among patients with successful NOM, liver-specific complications developed in 10.0% and were managed definitively without major sequelae.Conclusions: Nonoperative management was offered safely in two-thirds of grade 4 and grade 5 blunt liver injuries, with a 91.3% success rate. Only 6.5% of patients with NOM required a delayed operation because of liverspecific issues, and none experienced life-threatening complications because of the delay.

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Management of the Most Severely Injured Spleen

Abstract: Nearly two-thirds of patients with grade IV or V BSI require surgery. A grade V BSI and brain injury predict failure of NOM. This data must be taken into account when generalizations are made about the overall high success rates of NOM, which do not represent severe BSI.

Cited by 97 publications

References 21 publications

Blunt Trauma in Pediatric Patients- Experience from Small Center

Blunt Trauma in Pediatric Patients- Experience from Small Center

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

Successful Nonoperative Management of the Most Severe Blunt Liver Injuries

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