scholarly journals Safety of selective nonoperative management for blunt splenic trauma: the impact of concomitant injuries

2018 ◽  
Vol 12 (1) ◽  
Author(s):  
Michel Paul Johan Teuben ◽  
Roy Spijkerman ◽  
Taco Johan Blokhuis ◽  
Roman Pfeifer ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Nonoperative Management ◽  
Splenic Trauma ◽  
Concomitant Injuries ◽  
Blunt Splenic Trauma ◽  
Selective Nonoperative Management ◽  
The Impact

Does Splenic Embolization and Grade of Splenic Injury Impact Nonoperative Management in Patients Sustaining Blunt Splenic Trauma?

2011 ◽  
Vol 77 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Elan Jeremitsky ◽  
Amy Kao ◽  
Chad Carlton ◽  
Aurelio Rodriguez ◽  
Adrian Ong
Keyword(s):  
Splenic Injury ◽  
Nonoperative Management ◽  
Protective Measure ◽  
Splenic Trauma ◽  
Increased Risk ◽  
Splenic Embolization ◽  
Blunt Splenic Trauma ◽  
Injury Grade ◽  
The Impact ◽  
Grade Iii

Nonoperative management (NOM) for blunt splenic trauma (BST) is an established practice. The impact of splenic embolization (SE) in the algorithm for NOM has not been well studied. This study evaluates the role of SE and spleen injury grade on failure of NOM. Retrospective cohort of trauma registry over a 7-year period (2000-2006) for patients who suffered BST was studied. Data including demographics, splenic injury grade, and SE were recorded. Characteristics were compared between the successful and failed NOM groups. Kaplan-Meier, life table, and Cox-proportional hazard regression analyses were performed. Of the 499 patients who suffered BST, 407 (81.6%) patients had successful NOM and 92 (18.4%) patients failed NOM (including splenectomies performed within 1 hour of admission). Failed NOM group had a higher splenic injury grade compared with the successful NOM group ( P < 0.0001). Seventy-five per cent underwent a splenectomy within 7.7 hours of admission. Nearly all grade I and II splenic injuries that failed NOM occurred by 24 hours. Grade 3 and 4 injuries that failed NOM occurred by 150 hours. SE was protective against splenectomy (Hazard Ratio (HR) 0.18, 95% confidence interval: 0.06-0.55, P = 0.004), whereas splenic injury grades III or higher was associated with increased risk of splenectomy (grade III: HR 5.26, P = 0.003; grade IV: HR 6.84, P = 0.002; grade V: HR 9.81, P = 0.002) compared with those with splenic injury grade I. Splenic embolization is a protective measure to reduce the failure of NOM. Spleen injury grade III and higher was significantly associated with NOM failure and would require a 5-day inpatient observation.

scholarly journals Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Michel Teuben ◽  
Roy Spijkerman ◽  
Taco Blokhuis ◽  
Roman Pfeifer ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Mental Status ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Splenic Trauma ◽  
Blunt Splenic Injury ◽  
Icu Stay ◽  
Severity Scores ◽  
Gcs Score ◽  
The Impact

Abstract Background Treatment of blunt splenic injury has changed over the past decades. Nonoperative management (NOM) is the treatment of choice. Adequate patient selection is a prerequisite for successful NOM. Impaired mental status is considered as a relative contra indication for NOM. However, the impact of altered consciousness in well-equipped trauma institutes is unclear. We hypothesized that impaired mental status does not affect outcome in patients with splenic trauma. Methods Our prospectively composed trauma database was used and adult patients with blunt splenic injury were included during a 14-year time period. Treatment guidelines remained unaltered over time. Patients were grouped based on the presence (Group GCS: < 14) or absence (Group GCS: 14–15) of impaired mental status. Outcome was compared. Results A total of 161 patients were included, of whom 82 were selected for NOM. 36% of patients had a GCS-score < 14 (N = 20). The median GCS-score in patients with reduced consciousness was 9 (range 6–12). Groups were comparable except for significantly higher injury severity scores in the impaired mental status group (19 vs. 17, p = 0.007). Length of stay (28 vs. 9 days, p < 0.001) and ICU-stay (8 vs. 0 days, p = 0.005) were longer in patients with decreased GCS-scores. Failure of NOM, total splenectomy rates, complications and mortality did not differ between both study groups. Conclusion This study shows that NOM for blunt splenic trauma is a viable treatment modality in well-equipped institutions, regardless of the patients mental status. However, the presence of neurologic impairment is associated with prolonged ICU-stay and hospitalization. We recommend, in institutions with adequate monitoring facilities, to attempt nonoperative management for blunt splenic injury, in all hemodynamically stable patients without hollow organ injuries, also in the case of reduced consciousness.

scholarly journals Nonoperative Management of Adult Blunt Splenic Trauma

1989 ◽  
Vol 210 (5) ◽  
pp. 626-629 ◽  
Author(s):  
WALTER E. LONGO ◽  
CHRISTOPHER C. BAKER ◽  
MARVIN A. McMILLEN ◽  
IRVIN M. MODLIN ◽  
LINDA C. DEGUTIS ◽  
...  
Keyword(s):  
Nonoperative Management ◽  
Splenic Trauma ◽  
Blunt Splenic Trauma

Nonoperative Management of Blunt Splenic Trauma in Patients with Traumatic Brain Injury: Feasibility and Outcomes

2018 ◽  
Vol 42 (8) ◽  
pp. 2404-2411 ◽  
Author(s):  
Navpreet K. Dhillon ◽  
Galinos Barmparas ◽  
Gretchen M. Thomsen ◽  
Kavita A. Patel ◽  
Nikhil T. Linaval ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Nonoperative Management ◽  
Splenic Trauma ◽  
Blunt Splenic Trauma

scholarly journals Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

2015 ◽  
Vol 38 (5) ◽  
pp. 1143-1151 ◽  
Author(s):  
P. T. Foley ◽  
H. Kavnoudias ◽  
P. U. Cameron ◽  
C. Czarnecki ◽  
E. Paul ◽  
...  
Keyword(s):  
Immune Function ◽  
Splenic Artery ◽  
Splenic Trauma ◽  
Blunt Splenic Trauma ◽  
The Impact
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