Predictability of Splenic Salvage by Computed Tomography

Buntain, William L.; Gould, Howard R.; Maull, Kimball I.

doi:10.1097/00005373-198801000-00004

Cited by 110 publications

(28 citation statements)

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“…Fur thermore, this technique is of high performance for the diagnosis of splenic lesions but may underestimate their seriousness [6][7][8]. Splenic injury scores, based on CT scan data, have been put forward to discriminate rapidly between patients requiring surgery, and those who may benefit from conservative treatment [7,10,11,14], The use of these scores in the clinical context is controversial [3,6,9,15,16]. Comparison of score results is difficult due to differences in the type of patients studied (children-adults), and in the importance of splenic injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Buntain conserves 35% of spleens, and Mirvis 48% [7,9], Only isolated splenic lesions were studied so as to avoid a bias introduced by other lesions.…”

Section: ) Inhomogenicity O F the Splenic Lesions With Predomi Nancementioning

confidence: 99%

“…Therefore, this treatment is justifiable only if it does not give rise to risks superior to that of splenectomy itself. CT scan of the abdomen is a highly accurate meth od of diagnosing splenic injury, although the severity of the injury may be misjudged by the scan [6][7][8], CT scan ning should therefore help to orientate the handling of splenic trauma. Various scores have been established for the purpose of determining which splenic injuries can be managed nonoperatively, and which require surgery [7][8][9][10][11].…”

mentioning

confidence: 99%

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Isolated Blunt Splenic Trauma in Adults

Savioz¹,

Froment²,

Chilcott³

et al. 1997

Dig Surg

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Several CT scan scores have been proposed to discriminate between splenic injuries requiring surgical intervention, and those that may be treated conservatively. The aim of this study is to compare three selected CT scan scores (Buntain, Mirvis, Resciniti) in their ability to correctly define the proper course of therapy following splenic injury. 44 adult patients presenting an isolated splenic trauma, confirmed by CT scan on admission and treated solely according to clinical criteria, have been studied. The 44 CT scans were retrospectively classified according to the three CT scan scoring systems. Correlation with the treatment performed allows the specificity and sensitivity of each score to be calculated and compared. The best score (Resciniti) uses a combination of parenchymal and intra-abdominal liquid scores. The use of such a scoring system alone to dictate therapy would have resulted in either an increased rate of surgical intervention, or an unacceptable rate of failure of conservative treatment. However, the determination of the expected rate of failure of conservative treatment can be useful in determining the level and frequency of serial surveillance examinations.

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Section: Discussionmentioning

confidence: 99%

“…Buntain conserves 35% of spleens, and Mirvis 48% [7,9], Only isolated splenic lesions were studied so as to avoid a bias introduced by other lesions.…”

Section: ) Inhomogenicity O F the Splenic Lesions With Predomi Nancementioning

confidence: 99%

mentioning

confidence: 99%

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Isolated Blunt Splenic Trauma in Adults

Savioz¹,

Froment²,

Chilcott³

et al. 1997

Dig Surg

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“…The existing literature is divided into studies that support the use of CT scan data to predict the outcome of NOMSI 6,13,[16][17][18][19][20][21][22][23][24] and studies that report that CT information is unreliable for this purpose. [25][26][27][28][29] Many of the conclusions of these studies are limited, because pediatric and adult populations are mixed, 6,17 outcomes of liver and splenic injuries are reported together, 5,9,30 grading systems used differ, 11,18,22,26,27 and CT scan technology used during that time is outdated by current standards. 22,26,27 In this study, we describe only adult patients with splenic injury, graded by the currently used grading system of the American Association for the Surgery of Trauma.…”

Section: Comparison Between Ct and Operative Grading Of Splenic Injurymentioning

confidence: 99%

“…[25][26][27][28][29] Many of the conclusions of these studies are limited, because pediatric and adult populations are mixed, 6,17 outcomes of liver and splenic injuries are reported together, 5,9,30 grading systems used differ, 11,18,22,26,27 and CT scan technology used during that time is outdated by current standards. 22,26,27 In this study, we describe only adult patients with splenic injury, graded by the currently used grading system of the American Association for the Surgery of Trauma. 11 The splenic injury imaging data are acquired by helical CT. We also do not report on isolated CT scan data but combine it with physiologic criteria-in this case, the need for blood transfusion-to increase predictability.…”

Section: Comparison Between Ct and Operative Grading Of Splenic Injurymentioning

confidence: 99%

Nonoperative Management of Splenic Injuries

Velmahos

Chan²,

Kamel³

et al. 2000

Arch Surg

110

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Delayed Complications of Nonoperative Management of Blunt Adult Splenic Trauma

et al. 1998

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Setting: University teaching hospital, level I trauma center. Patients: Two hundred eighty patients were admitted to the adult trauma service with blunt splenic injury during a 4-year period. Men constituted 66% of the population. The mean (±SEM) age was 32.2±1.0 years and the mean (±SEM) Injury Severity Score was 22.8±0.9. Fiftynine patients (21%) died of multiple injuries within 48 hours and were eliminated from the study. One hundred thirty-four patients (48%) were treated operatively within the first 48 hours after injury and 87 patients (31%) were managed nonoperatively. Main Outcome Measures: We reviewed the number of units of blood transfused, intensive care unit length of stay, overall length of stay, outcome, and complications occurring more than 48 hours after injury directly attributable to the splenic injury. Results: Patients managed nonoperatively had a significantly lower Injury Severity Score (P<.05) than patients treated operatively. Length of stay was significantly decreased in both the number of intensive care unit days as well as total length of stay (P<.05). The number of units of blood transfused was also significantly decreased in patients managed nonoperatively (P<.05). Seven patients (8%) managed nonoperatively developed delayed complications requiring intervention. Five patients had overt bleeding that occurred at 4 days (3 patients), 6 days (1 patient), and 8 days (1 patient) after injury. Three patients underwent splenectomy, 1 had a splenic artery pseudoaneurysm embolization, and 1 had 2 areas of bleeding embolization. Two patients developed splenic abscesses at approximately 1 month after injury; both were treated by splenectomy. Conclusion: Significant numbers of delayed splenic complications do occur with nonoperative management of splenic injuries and are potentially lifethreatening.

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Predictability of Splenic Salvage by Computed Tomography

Cited by 110 publications

References 0 publications

Isolated Blunt Splenic Trauma in Adults

Isolated Blunt Splenic Trauma in Adults

Nonoperative Management of Splenic Injuries

Delayed Complications of Nonoperative Management of Blunt Adult Splenic Trauma

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