Nonoperative Management of Blunt Splenic Injury: A 5-Year Experience

Haan, James M.; Bochicchio, Grant V.; Krämer, Nils; Scalea, Thomas M.

doi:10.1097/01.ta.0000154575.49388.74

Cited by 321 publications

(234 citation statements)

References 23 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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“…Conversely, there is a higher failure rate of non-operative management with subsequent surgical repair in cases of a higher grade of injury. Splenic artery angiography with embolization is a viable alternative to surgical intervention in patients who are hemodynamically capable of tolerating the angiography (22). Although one previous publication found a 93% success rate in patients with traumatic spleen injury with angiography, results of angiography in colonoscopically induced injury has been mixed (9,23).…”

Section: A B Cmentioning

confidence: 99%

Splenic laceration after routine colonoscopy, a case report of a rare iatrogenic complication

Gupta

Kumar

et al. 2017

Transl. Gastroenterol. Hepatol.

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“…About 10% of these patients will be managed with urgent splenectomy (2)(3)(4). The remaining patients are managed using non-operative strategies that have developed over the last three decades (2,(5)(6)(7)(8)(9)(10)(11)(12)(13). This shift towards non-operative management (NOM) may have unintended consequences, such as delayed splenic rupture which is particularly worrisome in the outpatient setting (14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%