The splenic injury outcomes trial

Zarzaur, Ben L.; Kozar, Rosemary A.; Myers, John G.; Claridge, Jeffrey A.; Scalea, Thomas M.; Neideen, Todd; Maung, Adrian A.; Alarcon, Louis H.; Corcos, A; Kerwin, Andrew J.; Coimbra, Raúl

doi:10.1097/ta.0000000000000782

Cited by 97 publications

(41 citation statements)

References 37 publications

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“…In a 2015 AAST prospective observational study, Zarzaur et al investigated the risk of delayed splenectomy after NOM with or without SAE [ 38 ]. They found that the only risk factor for delayed splenectomy was the finding of active extravasation at presentation; thus calling for closer observation of patients with this finding irrespective of whether SAE was performed.…”

Section: Discussionmentioning

confidence: 99%

Splenic artery embolization: technically feasible but not necessarily advantageous

Cruyssen

Manzelli

2016

World J Emerg Surg

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BackgroundThe spleen is the second most commonly injured organ in cases of abdominal trauma. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management (NOM), splenic artery embolization (SAE), surgery (operative splenic salvage or splenectomy), or a combination of these treatments. In nonoperatively managed cases, SAE is sometimes used to control haemorrhage. However, the indications for SAE have not been clearly defined and, in some cases, the potential complications of the procedure may outweigh its benefits.Review of the literatureThrough review of the literature we address the question of when SAE is indicated in combination with NOM of splenic injury, and whether SAE may delay needed surgical treatment in some cases. This systematic review highlighted the use of imperfect and inconsistent scoring systems in the diagnosis of splenic injury, the lack of consensus regarding indications for SAE, and the potential for severe morbidities associated with this procedure. Based on current literature and evidence we provide a new, non-verified, decision algorithm.ConclusionsNOM+ SAE involves potential risks and operative management may be preferable to SAE for certain patients. To clarify current literature, we propose a new algorithm for blunt abdominal trauma that should be validated prospectively. New evidence-based protocols should be developed to guide diagnosis and management of patients with splenic trauma.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0100-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Splenic artery embolization: technically feasible but not necessarily advantageous

Cruyssen

Manzelli

2016

World J Emerg Surg

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“…When the presence of an actively bleeding vessel or ‘blush’ is noted on the initial CT scan, it is associated with more than a 20-fold increased risk of splenectomy. 2 …”

Section: Angioembolization: Pros and Consmentioning

confidence: 99%

“…1 Based on recent studies, as well as data from the American College of Surgeons National Trauma Data Bank, 10% to 15% of patients admitted with blunt splenic injury will undergo an urgent splenectomy within six hours of admission, primarily due to ongoing bleeding and hemorrhagic shock. 2 The remaining patients with blunt splenic injury are considered for nonoperative management and most of them are successfully managed in this manner.…”

Section: Introductionmentioning

confidence: 99%

An update on nonoperative management of the spleen in adults

Zarzaur

Rozycki

2017

Trauma Surg Acute Care Open

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“…Observation, with or without angiography, has been advocated for children and adults, as well as for low- and high-grade injuries in stable patients. 6 Non-operative management has been shown to be safe, with approximately 10% of patients proceeding to operation for deteriorating clinical status within 24 hours, and approximately 3% requiring later splenectomy. 5–8 However, there is considerable variation in practice among surgeons and between centers with respect both to criteria for nonoperative management, and for the details of this practice.…”

Section: Introductionmentioning

confidence: 99%

Variation in intensive care unit utilization and mortality after blunt splenic injury

Kaufman

Wiebe²,

Martin³

et al. 2016

Journal of Surgical Research

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Background While trauma patients are frequently cared for in the ICU, admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. Materials and Methods We conducted a retrospective cohort study of patients treated for blunt splenic injuries at 30 level I and II Pennsylvania trauma centers, 2011–2014. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman’s rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement, between high- and low-ICU-utilization centers. Results Of 2,587 patients with blunt splenic injuries, 63.9% (1,654) were admitted to the ICU. Median injury severity score (ISS) was 17 overall, 13 for non-ICU patients and 17 for ICU patients (p < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9% to 87.3%. Risk-adjusted mortality rates ranged from 1.2% to 9.6%. There was no correlation between O:E ratios for ICU utilization and mortality (rs = −0.2595, p=0.2103). Proportionately fewer ICU patients at high-utilization centers received critical care procedures than at low-utilization centers. Conclusions Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality.

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The splenic injury outcomes trial

Cited by 97 publications

References 37 publications

Splenic artery embolization: technically feasible but not necessarily advantageous

Splenic artery embolization: technically feasible but not necessarily advantageous

An update on nonoperative management of the spleen in adults

Variation in intensive care unit utilization and mortality after blunt splenic injury

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