Splenic injury admitted to a rural <scp>L</scp>evel 3 trauma centre: A 10‐year audit

Hoskins, Wayne; Jacob, Abraham; Wijeratne, Shiran; Campbell, I. A.; Taylor, Peter A.

doi:10.1111/ajr.12035

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…CT is superior to ultrasonography, due to the fact that it is a less operatordependent method, offering higher sensitivity for the detection of solid organ injuries. In the study by Hoskins et al (8), which evaluated patients who sustained splenic injury, the delay in performing CT was associated with a delay in surgery and the occurrence of major postoperative complications. The same study also concluded that among patients having a higher risk for developing splenic injury, those who sustained high-energy trauma and who exhibited hemodynamic instability should be considered high-risk patients and should undergo CT as early as possible.…”

Section: Discussionmentioning

confidence: 99%

Increasing Risk Over Time: Delayed Spleen Rupture After Trauma

Meral¹,

Hançerlioğulları²,

Ilıca³

et al. 2014

JAEMCR

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Introduction: Delayed rupture of the spleen is defined as splenic rupture occurring 48 hours or more after blunt abdominal trauma. The diagnostic process should involve the timely and proper use of focused assessment with sonography for trauma (FAST) and computerized tomography (CT). Case Report: Our study hereby reports a case of a 21-year-old male patient who sustained a blunt abdominal trauma and who was subsequently discharged due to the observation of normal findings on the initial physical examination, ultrasonography, and CT. The patient was re-admitted to the hospital 15 days later with worsening complaints, after which he was diagnosed with splenic rupture and discharged from the hospital with full recovery after splenectomy. Conclusion: The possibility of delayed splenic rupture should not be overlooked in blunt abdominal trauma patients with normal physical examination findings and a problem-free medical history. Although repeated physical examination and FAST are important diagnostic procedures, CT should be performed without delay in the presence of a high-energy trauma and hemodynamic instability. Olgu Sunumu: Çalışmamızda künt batın travması ile başvuran; ilk başvurusunda muayenesi, ultrasonografi ve BT tetkikleri normal olarak değerlendirilip önerilerle taburcu edilen 21 yaşındaki erkek hastaya ait olgu sunulmaktadır. 15 gün sonra artan şikayetlerle hastaneye başvuran hastada dalak rüptürü tespit edilmiş, splenektomi sonrası şifa ile taburcu edilmiştir. Sonuç: Fizik muayene bulguları ve tıbbi öyküsü normal olan künt batın travmalı hastalarda gecikmiş dalak rüptürü olasılığı göz ardı edilmemelidir. Tekrarlanan fizik muayene ve FAST önemli tanısal yöntemler olmakla birlikte yüksek enerjili travma ve hemodinamik instabilite bulunması durumunda BT gecikmeden uygulanmalıdır.

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Section: Discussionmentioning

confidence: 99%

Increasing Risk Over Time: Delayed Spleen Rupture After Trauma

Meral¹,

Hançerlioğulları²,

Ilıca³

et al. 2014

JAEMCR

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“…Thus, lower-level trauma centers with limited resources must expeditiously decide who can be immediately transferred to a higher level of care for SAE and who can be safely admitted for either surgery (exploratory laparotomy and splenectomy) or observation. Although there are a proliferation of studies examining the triage of splenic injuries [3,[6][7][8][9][10][11][12][13][14][15], there are a paucity of studies on management of patients with blunt splenic injuries in remote settings and of the few that exist, most report very small numbers and are not current [16,17]. There continues to be great variability in the processes of care for splenic injury patients, with sparse data reported across Level III or IV trauma centers.…”

Section: Introductionmentioning

confidence: 99%

Predictors of transfer from a remote trauma facility to an urban level I trauma center for blunt splenic injuries: a retrospective observational multicenter study

McGraw

Mains²,

Taylor

et al. 2022

Patient Saf Surg

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Background The decision-making for admission versus emergent transfer of patients with blunt splenic injuries presenting to remote trauma centers with limited resources remains a challenge. Although splenectomy is standard for hemodynamically unstable patients, the specific criterion for non-operative management continues to be debated. Often, lower-level trauma centers do not have interventional radiology capabilities for splenic artery embolization, leading to transfer to a higher level of a care. Thus, the aim of this study was to identify specific characteristics of patients with blunt splenic injuries used for admittance or transfer at a remote trauma center. Methods A retrospective observational study was performed to examine the management of splenic injuries at a mountainous and remote Level III trauma center. Trauma patients ≥ 18 years who had a blunt splenic injury and initially received care at a Level III trauma center prior to admittance or transfer were included. Data were collected over 4.5 years (January 1, 2016 – June 1, 2020). Patients who were transferred out in > 24 h were excluded. Patient demographics, injury severity, spleen radiology findings, and clinical characteristics were compared by decision to admit or transfer to a higher level of care ≤ 24 h of injury. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Multivariable logistic models were used to identify predictors of transfer. Results Of the 73 patients included with a blunt splenic injury, 48% were admitted and 52% were transferred to a Level I facility. Most patients were male (n = 58), were a median age of 26 (21–42) years old, most (n = 62) had no comorbidities, and 47 had been injured from a ski/snowboarding accident. Compared to admitted patients, transferred patients were significantly more likely to be female (13/38 vs. 3/36, p = 0.007), to have an abbreviated injury scale score ≥ 3 of the chest (31/38 vs. 7/35, p = 0.002), have a higher injury severity score (16 (16–22) vs. 13 (9–16), p = 0.008), and a splenic injury grade ≥ 3 (32/38 vs. 12/35, p < 0.001). After adjustment, splenic injury grade ≥ 3 was the only predictor of transfer (OR: 12.1, 95% CI: 3.9–37.3, p < 0.001). Of the 32 transfers with grades 3–5, 16 were observed, and 16 had an intervention. Compared to patients who were observed after transfer, significantly more who received an intervention had a blush on CT (1/16 vs. 7/16, p = 0.02) and a higher median spleen grade of 4 (3–5) vs. 3 (3–3.5), p = 0.01). Conclusions Our data suggest that most patients transferred from a remote facility had a splenic injury grade ≥ 3, with concomitant injuries but were hemodynamically stable and were successfully managed non-operatively. Stratifying by spleen grade may assist remote trauma centers with refining transfer criteria for solid organ injuries.

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“…However, little is published about SAE in transferred trauma patients. A search in PubMed with the terms “splenic AND injury AND transfer” yielded only one paper describing six cases [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The treatment of spleen injuries: a retrospective study

Dehli

Bågenholm

Trasti

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundHemorrhage after blunt trauma is a major contributor to death after trauma. In the abdomen, an injured spleen is the most frequent cause of major bleeding. Splenectomy is historically the treatment of choice. In 2007, non-operative management (NOM) with splenic artery embolization (SAE) was introduced in our institution. The indication for SAE is hemodynamically stable patients with extravasation of contrast, or grade 3–5 spleen injury according to the Abbreviated Organ Injury Scale 2005, Update 2008. We wanted to examine if the introduction of SAE increased the rate of salvaged spleens in our trauma center.MethodAll patients discharged with the diagnosis of splenic injury in the period 01.01.2000 – 31.12.2013 from the University Hospital of North Norway Tromsø were included in the study. Patients admitted for rehabilitation purposes or with an iatrogenic injury were excluded.ResultsA total of 109 patients were included in the study. In the period 2000-7, 20 of 52 patients were splenectomized. During 2007-13, there were 6 splenectomies and 24 SAE among 57 patients. The reduction in splenectomies is significant (p < 0.001). There is an increase in the rate of treated patients (splenectomy and SAE) from 38 to 53 % in the two time periods, but not significantly (p = 0.65).ConclusionThe rate of salvaged spleens has increased after the introduction of SAE in our center.Trial registrationThe study is registered at www.clinicaltrials.gov with the identification number NCT01965548.

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Splenic injury admitted to a rural Level 3 trauma centre: A 10‐year audit

Abstract: Although splenic injury is uncommon in the Wimmera region, improved trauma triaging is required, with early transfer of unstable patients and high-energy trauma mechanisms. A lower threshold for computed tomography scanning is recommended.

Cited by 6 publications

References 16 publications

Increasing Risk Over Time: Delayed Spleen Rupture After Trauma

Increasing Risk Over Time: Delayed Spleen Rupture After Trauma

Predictors of transfer from a remote trauma facility to an urban level I trauma center for blunt splenic injuries: a retrospective observational multicenter study

The treatment of spleen injuries: a retrospective study

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