Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol

Brillantino, Antonio; Iacobellis, Francesca; Robustelli, Umberto; Villamaina, Elisabetta; Maglione, Franco; Colletti, O.; Palma, Maurizio De; Paladino, Fiorella; Noschese, Giuseppe

doi:10.1007/s00068-015-0575-z

Cited by 53 publications

(38 citation statements)

References 32 publications

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“…In another study serial CEUS follow-up examinations in a few patients with mild liver and spleen trauma were performed and CEUS was considered to be particularly suited to the follow-up of this kind of lesion [16]. As in some other previous studies, we reported a very low NOM failure rate [14,15,17] and this could be related to the high rate of blunt abdominal trauma with splenic injury that underwent splenic angioembolization after the CT performed in the ED in our cohort. In fact, a previous study demonstrated that high splenic angioembolization rates could reduce NOM failure [18].…”

Section: Discussionsupporting

confidence: 67%

“…injuries, particularly in hemodynamically stable patients with isolated blunt low or moderate-energy abdominal trauma [8][9][10][11]. Some previous studies showed that CEUS can detect active bleeding [12,13] and that performing one or two CEUS during follow-up is useful [14,15]. In another study serial CEUS follow-up examinations in a few patients with mild liver and spleen trauma were performed and CEUS was considered to be particularly suited to the follow-up of this kind of lesion [16].…”

Section: Discussionmentioning

confidence: 99%

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Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

2019

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Aims: To assess contrast enhanced ultrasound (CEUS) performance in the prediction of non-operatively managed blunt spleen injuries requiring only observation and monitoring during follow-up and to evaluate if CEUS accuracy was higher than conventional ultrasound (US) in this field.Material and methods: In 112 hemodynamic stable blunt spleen trauma patients, CEUS was performed for follow-up after computed tomography evaluation in the emergency department. CEUS and US performance were assessed considering as true negative cases patients that had not underwent interventional or surgical treatment during follow-up and were assessed as negative for splenic complications respectively by CEUS or US examinations.Results: CEUS showed sensitivity of 100%, specificity of 96.1%, positive predictive value of 69.2%, negative predictive value of 100.0% and accuracy of 96.4%. CEUS showed a significantly higher accuracy than conventional US (p=0.013).Conclusions: CEUS is a very useful imaging modality during follow-up of blunt splenic trauma non-operatively managed, allowing an efficientprediction of splenic injuries requiring only observation and monitoring during follow-up.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

2019

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“…Recently, as the quality of non‐operative management (NOM) has developed, blunt injuries to visceral organs such as spleen, liver, or kidney are tending to be managed non‐operatively with a high rate of success 1, 2, 3. However, NOM of these injuries sometimes leads to critical delayed complications and the possibility of lethal damage for the patients 4.…”

Section: Aimmentioning

confidence: 99%

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Uchida

Mizobata

Hagawa

et al. 2018

Acute Medicine & Surgery

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AimBlunt injuries to visceral organs have the potential to lead to delayed pseudoaneurysm formation or organ rupture, but current trauma and surgical guidelines do not recommend repetitive imaging. This study examined the incidence and timing of delayed undesirable events and established advisable timing for follow‐up imaging and appropriate observational admission.MethodsPatients with blunt splenic (S), liver (L), or kidney (K) injury treated with non‐operative management (NOM) in our institution were included and retrospectively reviewed.ResultsFrom January 2013 to January 2017, 57 patients were admitted with documented blunt visceral organ injuries and 22 patients were excluded. Of 35 patients (L, 10; S, 17; K, 6; L & S, 1; S & K, 1) treated with NOM, 14 (L, 4; S, 9; K, 1) patients underwent transcatheter arterial embolization. Delayed undesirable events occurred in four patients: three patients with splenic pseudoaneurysm on hospital day 6–7 and one patient with splenic delayed rupture on hospital day 7. The second follow‐up computed tomography scan carried out 1–2 days after admission did not show any significant findings that could help predict undesirable results of delayed events. The patients with delayed events had longer continuous abdominal pain than that of event‐free patients (P = 0.04).ConclusionsUndesirable delayed events were recognized on follow‐up computed tomography scans in 11.4% of NOM patients at hospital day 6–7 and tended to be associated with high‐grade splenic injuries and continuous symptoms. Repetitive screening of these patients 6–7 days after injury might be warranted because of the potential risk of delayed events.

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“…31 Within the abdomen, pseudoaneurysms are most frequently encountered in the spleen, since this is the most commonly injured abdominal organ in blunt trauma. 5,43 An accurate identification is crucial, since angiographic embolization is the treatment of choice (Figures 4-6). 5,25,43 MDCT protocol should include an arterial phase, 1,14,25,43 since it allows the detection of AVF and improves the detection of pseudoaneurysm in the spleen ( Figure 5).…”

Section: Pseudoaneurysmsmentioning

confidence: 99%

“…5,43 An accurate identification is crucial, since angiographic embolization is the treatment of choice (Figures 4-6). 5,25,43 MDCT protocol should include an arterial phase, 1,14,25,43 since it allows the detection of AVF and improves the detection of pseudoaneurysm in the spleen ( Figure 5). 14,24 The arterial phase allows the identification of the circumscribed area of medium contrast attenuation with the wash in and washout similar to those of the contiguous artery; however, in the portal venous phase, the attenuation is similar to the parenchyma.…”

Section: Pseudoaneurysmsmentioning

confidence: 99%

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications

Iacobellis

Ierardi

Mazzei

et al. 2016

BJR

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Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.

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Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol

Cited by 53 publications

References 32 publications

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications

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