Nonoperative Management of Splenic Injuries

Velmahos, George C.; Chan, Linda S.; Kamel, Eman; Murray, James A.; Yassa, Nabil A.; Kahaku, Deborah; Berne, Thomas V.; Δημητριάδης, Δημήτριος

doi:10.1001/archsurg.135.6.674

Cited by 110 publications

(75 citation statements)

References 27 publications

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“…2,4,8,9,32 In the present study, the age of the patient did not affect the risk of delayed rupture of any solid organ. Higher organ injury grades and Injury Severity Scores were found to be significantly associated with delayed splenic rupture, although this was not true for renal or hepatic injuries.…”

Section: Commentmentioning

confidence: 43%

“…Most delayed ruptures happen within several days of the injury, but longer delays have been reported. 4,6,7,9,[15][16][17] To decrease the risk of delayed hemorrhage, many surgeons have incorporated a period of strict bed rest into their protocols of NOM. 6,9,12,[18][19][20][21][22] The presumed rationale is that patient movement or an unexpected fall may disrupt a stable clot, leading to hemorrhage and the need for operative intervention.…”

mentioning

confidence: 99%

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Safety of Early Mobilization of Patients With Blunt Solid Organ Injuries

et al. 2008

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Background: Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage.Objective: To determine whether there is an association between the day of mobilization and rates of delayed hemorrhage from blunt solid organ injuries.Design: Retrospective cohort study. Univariate and multivariate analyses were performed to determine the association of mobilization with delayed hemorrhage of a solid organ requiring laparotomy.Setting: Level I trauma center.Patients: Adults with blunt renal, hepatic, or splenic injuries were identified from a trauma registry.Main Outcome Measures: Medical records were used to determine the day of mobilization and to identify patients with delayed hemorrhage requiring laparotomy.Results: Four hundred fifty-four patients with blunt solid organ injuries were admitted to the hospital for nonoperative management. Failure rates of nonoperative management were 4.0%, 1.0%, and 7.1% for renal, hepatic, and splenic injuries, respectively. No patients with renal or hepatic injuries failed secondary to delayed hemorrhage. Ten patients (5.5%) with splenic injuries failed secondary to delayed hemorrhage. Eighty-four percent of patients with renal injuries, 80% with hepatic injuries, and 77% with splenic injuries were mobilized within 72 hours of admission. Day of mobilization was not associated with delayed splenic rupture in multivariate analysis (odds ratio, 0.97; 95% confidence interval, 0.90-1.05). Conclusions:The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.

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Section: Commentmentioning

confidence: 43%

mentioning

confidence: 99%

Safety of Early Mobilization of Patients With Blunt Solid Organ Injuries

et al. 2008

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“…Intrasplenic arterial pseudoaneurysms appear on CT images as foci of contrast enhancement not conforming to intact vessels but closely matching the attenuation of intraarterial blood; the lesions do not increase in size on consecutive phase images obtained during a single examination, but do exhibit washout of enhancement synchronous with contrast agent clearance from intact arteries (11,18). CT features of EMERGENCY RADIOLOGY: Trauma CT Protocol for Blunt Splenic Injury Boscak et al management (20,21), the published literature is contradictory regarding the relationship between splenic injury grade and incidence of intrasplenic vascular injury. While some studies have demonstrated positive correlation between contained vascular injury and AAST grade (16,22), other studies have questioned the presence of a reliable association (4,23), and it is clear that these lesions do occur in low-grade injury (4,11).…”

Section: Discussionmentioning

confidence: 99%

Optimizing Trauma Multidetector CT Protocol for Blunt Splenic Injury: Need for Arterial and Portal Venous Phase Scans

et al. 2013

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“…Splenectomy is required for around 50% of splenic trauma injuries (Velmahos et al, 2000). The white blood cell count (WBC) is an integral part of sepsis diagnosis.…”

Section: Discussionmentioning

confidence: 99%