Predictors of surgical management of high grade blunt splenic injuries in adult trauma patients: a 5-year retrospective cohort study from an academic level I trauma center

Abstract

Backgrounds Splenic injury accounts for 40% of all injuries after blunt abdominal trauma. Blunt splenic injury in hemodynamically unstable patients is preferably treated by splenectomy. Nowadays hemodynamically stable patients with low grade splenic injuries are mostly treated by non-operative management (NOM). However no consensus exists about the management of high grade splenic injuries in hemodynamically stable patients. Therefore the aim of this study was to analyze patients with high grade splenic injuries in our institution. Methods We retrospectively included all patients with a splenic injury presented to our level I trauma center during the 5-year period from January 1, 2012, until December 31, 2017. Baseline characteristics, data regarding complications and mortality were collected from the electronic patient registry. Patients were grouped based on splenic injury and the treatment they received. Results A total of 123 patients were included, of which 93 (75.6%) were male with a median age of 31 (24–52) and a median injury severity score of 27 (17–34). High grade injuries ( n = 28) consisted of 20 Grade IV injuries and 8 grade V injuries. Splenectomy was required in 15/28 (53.6%) patients, of whom all remained hemodynamically unstable after resuscitation, including all grade V injuries. A total of 13 patients with high grade injuries were treated with spleen preserving therapy. Seven of these patients received angio-embolization. One patient went for laparotomy and the spleen was treated with a hemostatic agent. Secondary hemorrhage was present in 3 of these patients (initial treatment: 1 embolization/ 2 observational), resulting in a success rate of 76.9%. There is no mortality seen in patient with high grade splenic injuries. Conclusion Non-operative treatment in high grade splenic injuries is a safe treatment modality in hemodynamically stable patients. Hemodynamic status and peroperative bleeding, not injury severity or splenic injury grade were the drivers for surgical management by splenectomy. This selected cohort of patients must be closely monitored to prevent adverse outcomes from secondary delayed bleeding in case of non-operative management.

A special acute care surgery model for dealing with dilemmas involved in emergency department in China

“…From our experience, patient selection may have an impact not only on the rate of failure of NOM, but the mortality rate associated with it. Nowadays, the presence of hemodynamic instability is considered the only absolute contraindication for NOM 13 . Ongoing research is needed to evaluate whether to treat the patient operatively or with selective NOM, potentially leading to reduced LOS.…”

Trauma Abdominal / Abdominal trauma

“…Em decorrência do trauma sofrido associado a comorbidades prévias, os pacientes politraumatizados podem desenvolver um quadro clínico potencialmente mais grave, e o que se tem de mais prevalente é a hipotermia, acidose metabólica e coagulopatia e essa tríade em geral é o principal mecanismo de morte secundário ao trauma. (NIJDAM et al, 2020). Pela associação da extensão das lesões e a resposta endrocrino metabólica ao trauma, foi observado que o paciente apresenta maior mortalidade por falência metabólica do que a abordagem Brazilian Journal of Health Review, Curitiba, v.4, n.5, p. 23346 -23353 sep./oct.…”

“…Traumas penetrantes são causados basicamente por ferimentos com arma de fogo (PAF), e são responsáveis por uma parcela considerável de lesões na rotina do pronto atendimento, e também temos os ferimentos por arma branca (FAB) e nesse caso o órgão mais acometido é o fígado. (NIJDAM et al, 2020).…”

An Overview on Splenic Trauma Management Approach

“…[10] However, staging is not always a determinant of surgery, instead, it is hemodynamic status and peri-operative intra-peritoneal bleeding that are the main indications for surgical intervention. [11] Other factors include the presence of comorbid conditions or other traumatic injuries. Patients who are hemodynamically unstable should be offered intravenous fluid bolus, those who do not respond well to fluids or transiently respond before deteriorating are considered as high-risk for underlying organ laceration, including splenic and liver trauma.…”

“…Patients who are hemodynamically unstable should be offered intravenous fluid bolus, those who do not respond well to fluids or transiently respond before deteriorating are considered as high-risk for underlying organ laceration, including splenic and liver trauma. [11] Research has reported a risk of splenic rupture in patients infected with the coronavirus-19 disease, this is best managed with emergency surgery. In such infected patients with sudden severe abdominal pain, a low threshold for entering the operating theatre is practiced.…”