“…Usually, NOM is considered for hemodynamically stable patients to preserve immune function, as well as to reduce postoperative complications and costs of hospitalization. Several studies have advocated the safety, efficacy, and high success rate of selective NOM [3,6]. In adults, successful NOM has been reported in up to 85% cases (failure rate ≈8–38%) [8].…”
Section: Discussionmentioning
confidence: 99%
“…In earlier practice, blunt splenic injury (BSI) was managed surgically in most cases (OM) with splenectomy in adults, but splenorrhaphy was the preferred alternative for splenic salvage in children due to risk of overwhelming post-splenectomy infection and sepsis (OPSI) [2]. The diagnosis and management of BSI have significantly evolved over the past few decades [3]. The increased understanding of splenic function in immunological process and identification of post-splenectomy complications have led physicians to prefer the non-operative management (NOM) [4].…”
BackgroundSplenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution.Material/MethodsA retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients.ResultsA total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury.ConclusionsMost BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.
“…Usually, NOM is considered for hemodynamically stable patients to preserve immune function, as well as to reduce postoperative complications and costs of hospitalization. Several studies have advocated the safety, efficacy, and high success rate of selective NOM [3,6]. In adults, successful NOM has been reported in up to 85% cases (failure rate ≈8–38%) [8].…”
Section: Discussionmentioning
confidence: 99%
“…In earlier practice, blunt splenic injury (BSI) was managed surgically in most cases (OM) with splenectomy in adults, but splenorrhaphy was the preferred alternative for splenic salvage in children due to risk of overwhelming post-splenectomy infection and sepsis (OPSI) [2]. The diagnosis and management of BSI have significantly evolved over the past few decades [3]. The increased understanding of splenic function in immunological process and identification of post-splenectomy complications have led physicians to prefer the non-operative management (NOM) [4].…”
BackgroundSplenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution.Material/MethodsA retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients.ResultsA total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury.ConclusionsMost BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.
“…Another interesting factor is that chest radiography, in some cases of trauma, consists only of the anteroposterior position, a fact that reduces the possibility of diagnosis of small amounts of liquid which is better seen in the lateral view. If the CT scan had been used in all patients, certainly the amount of fluid in the pleural cavity would be higher, since it is known that CT is an excellent imaging method for rapid diagnosis, especially for evaluation of hemodynamically stable patients with blunt abdominal trauma 25 . However, even if the number of complications due to the RH had been underestimated in this study, the routinely use of CT scan would be unthinkable due to financial cost and the radiation risk.…”
Objective:to analyze the associated factors with empyema in patients with post-traumatic retained hemothorax.Methods:prospective observational study. Data were collected in patients undergoing PD during emergency duty. Variables analyzed were age, sex, mechanism of injury, side of the chest injury, intrathoracic complications of RH, laparotomy, specific injuries, rib fractures, trauma scores, days to diagnosis, diagnostic method of RH, primary indication of PD, initial volume drained, length of the first tube removal, surgical procedure. Cumulative incidence of empyema, pneumonia and pulmonary contusion and the proportion of patients with empyema or without empyema in each category of each variable analyzed were obtained.Results: the cumulative incidence of PD among trauma patients was 1.83% and the RH among those with PD was 10.63%. There were 20 cases of empyema (32.8%). Most were male in the age from 20 to 29, victims of injury by firearm on the left side of the thorax. The incidence of empyema in patients with injury by firearms was lower compared to those with stab wound or blunt trauma; higher among those with drained volume between 300 and 599 ml. The median hospital lenght of stay was higher among those with empyema.Conclusion:the incidence of PD was 1.83% and RH was 10.63%, these results are consistent with the low severity of the patients involved in this study and consistent with the literature. The incidence of empyema proved to be negatively associated with the occurrence of injury by firearms and positively associated with a drained volume between 300 and 599 ml, compared with lower or higher volumes.
“…NOM is associated with lower hospital costs, fewer non-therapeutic laparotomies laparotomies, a lower rate of intra-abdominal complications, lower rates of blood transfusion, and decreased morbidity and mortality [8, 9]. …”
SummaryBackgroundNon-operative management (NOM) of blunt hepatic and splenic injuries has become popular in haemodynamically stable adult patients, despite uncertainty about efficacy, patient selection, and details of management. Up-to-date strategies and practical recommendations are presented.MethodsA selective literature search was conducted in PubMed and the Cochrane Library (1989–2016).ResultsNo randomized clinical trial was found. Non-randomized controlled trials and large retrospective and prospective series dominate. Few systematic reviews and meta-analyses are available. NOM of selected patients with blunt liver and spleen injuries is associated with low morbidity and mortality. Only data of limited evidence are available on intensity and duration of patient monitoring, repeat imaging, antithrombotic prophylaxis and return to normal activity. There is high-level evidence on early mobilisation and post-splenectomy vaccination.ConclusionNOM of blunt liver or spleen injuries is a worldwide trend, but the literature does not provide high-grade evidence for this strategy.
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