1887
  1. Home
  2. A-Z Publications
  3. Journal of Emergency Medicine, Trauma and Acute Care
  4. Volume 2021, Issue 3
  5. Article
Volume 2021, Issue 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

There are shared guidelines about Non-Operative Management (NOM) of splenic injuries, but some unanswered questions remain. The aim of the present study is to establish the usefulness of a standardized protocol for management and follow-up of NOM patients with splenic injuries. Multicenter retrospective observational study including patients with major blunt trauma (ISS >15) with splenic injuries managed between January 1st 2014 and December 31st 2016 in two Italian I level Trauma Centers: one with a standardized management and follow-up protocol for NOM (Bufalini Hospital, Cesena, BH), and the other without it (ASST Papa Giovanni XXIII Hospital, Bergamo, PG23H). Comparison between patients’ outcomes were performed and a propensity score model was calculated. 47 patients managed in BH and 49 patients in PG23H were included. In BH, a higher proportion of patients was treated with NOM (72.3 % vs. 53.1 %, p = 0.051). There was no difference in complication rate and mortality in patients treated with NOM in the two hospitals. A borderline significant trend to a higher NOM failure rate in PG23H was found (BH 0.0 % vs. PG23H 11.3 %, p = 0.076). The total splenic conservation rate was significantly higher in BH (BH 72.3 % vs. PG23H 46.9 %, p = 0.011). After the Propensity Score based matching, 72 patients were included and the total splenic conservation rate was significantly higher in BH (BH: 77.8 % vs. PG23H: 50.9 %, p = 0.014). The application of a protocol for in-hospital management and follow-up for NOM of patients with splenic injury could decrease the NOM failure rate and improve splenic conservation rate.

© 2021 Fugazzola, Battisti, Tomasoni, Magnone, Pisano, Piazzalunga, Bisulli, Gamberini, Agnoletti, Coccolini, Giampalma, Ansaloni, licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2021.22
2021-10-22
2024-04-19
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2021/3/jemtac.2021.22.html?itemId=/content/journals/10.5339/jemtac.2021.22&mimeType=html&fmt=ahah

References

  1. Coccolini F, Montori G, Catena F, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017; 12: (1).
     [Google Scholar]
  2. Stassen NA, Bhullar I, Cheng JD, et al. Selective nonoperative management of blunt splenic injury?: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012; 73:(5): S294-300.
     [Google Scholar]
  3. Hafiz S, Desale S, Sava J, Columbia D. The impact of solid or:gan injury management on the US health care system. J Trauma Acute Care Surg. 2014; 77:(2)310–4.
     [Google Scholar]
  4. Gaspar B, Negoi I, Paun S, Hostiuc S, Ganescu R, Beuran M. Selective nonoperative management of abdominal injuries in polytrauma patients: A protocol only for experienced trauma centers. MAEDICA – a J Clin Med. 2014; 9:(2):168–72.
     [Google Scholar]
  5. Coccolini F, Fugazzola P, Morganti L, et al. The World Society of Emergency Surgery (WSES) spleen trauma classification: A useful tool in the management of splenic trauma. World J Emerg Surg. 2019; 14:(1).
     [Google Scholar]
  6. Lyass S, Sela T, Lebensart PD, Muggia-Sullam M. Follow-up imaging studies of blunt splenic injury: Do they influence management? Isr Med Assoc J. 2001; 3:(10):731–3..
     [Google Scholar]
  7. Liechti R, Fourie L, Stickel M, et al. Routine follow-up imaging has limited advantage in the non-operative management of blunt splenic injury in adult patients. Injury. 2020; 51:(4):863-70.
     [Google Scholar]
  8. Gomez D, Haas B, Al-ali K, Monneuse O, Nathens AB, Ahmed N. Controversies in the management of splenic trauma. Injury. 2012; 43:(1):55–61.
     [Google Scholar]
  9. Tagliati C, Argalia G, Polonara G, Giovagnoni A, Marco G. Contrast - enhanced ultrasound in delayed splenic vascular injury and active extravasation diagnosis. Radiol Med. 2019; 124:(3):170-5.
     [Google Scholar]
  10. Odedra D, Vincent M, Michael P. A 2019 international survey to assess trends in follow-up imaging of blunt splenic trauma. Emerg Radiol. 2020; 27:(1):51-56.
     [Google Scholar]
  11. Fugazzola P, Morganti L, Coccolini F, et al. The need for red blood cell transfusions in the emergency department as a risk factor for failure of non-operative management of splenic trauma: a multicenter prospective study. Eur J Trauma Emerg Surg. 2020; 46:(2): 407-12.
     [Google Scholar]
  12. Peitzman AB, Harbrecht BG, Rivera L, Heil B. Failure of observation of blunt splenic injury in adults: Variability in practice and adverse consequences. J Am Coll Surg. 2005; 201:(2): 179–87.
     [Google Scholar]
  13. Renzulli P, Gross T, Schnuriger B, et al. Management of blunt injuries to the spleen. Br J Surg. 2010; 97::1696–703.
     [Google Scholar]
  14. Bee TK, Croce MA, Miller PR, et al. Failures of splenic nonoperative management?: Is the glass half empty or half Full?? J Trauma. 2001; 50:(2): 2306.
     [Google Scholar]
  15. Nix JA, Costanza M, Daley BJ, et al. Outcome of the current management of splenic injuries. J Trauma. 1999; 50:(5):835-42.
     [Google Scholar]
  16. Mcintyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries. Arch Surg. 2005: 104:(6):563-69.
     [Google Scholar]
  17. Ong AW, Eilertson KE, Reilly EF, et al. Nonoperative management of splenic injuries?: Significance of age. J Surg Res. 2016; 201:(1):134–40.
     [Google Scholar]
  18. Bhullar IS, Frykberg ER, Siragusa D, et al. Age does not affect outcomes of nonoperative management of blunt splenic trauma. J Am Coll Surg. 2012; 214:(6):958–64.
     [Google Scholar]
  19. Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults: Multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma-Injury Infect Crit Care. 2000; 49:(2):177–89.
     [Google Scholar]
  20. Malhotra AK, Latifi R, Fabian TC, et al. Multiplicity of solid organ injury?: Influence on management and outcomes after blunt abdominal trauma. J Trauma. 2003; 54:(5):925–9.
     [Google Scholar]
  21. Cocanour CS, Moore FA, Ware DN, Marvin RG, Duke JH. Age should not be a consideration for nonoperative management of blunt splenic injury. J Trauma. 2000; 48:(4):606-12.
     [Google Scholar]
  22. Harbrecht BG, Peitzman AB, Rivera L, et al. Contribution of age and gender to outcome of blunt splenic injury in adults?: Multicenter study of the Eastern Association for the Surgery of Trauma. J Trauma. 2001; 51:(5):887–95.
     [Google Scholar]
  23. Armstrong RA, Macallister A, Walton B, Thompson J. Successful non-operative management of haemodynamically unstable traumatic splenic injuries: 4-year case series in a UK major trauma centre. Eur J Trauma Emerg Surg [Internet]. 2019; 45:(5):933–8. Available from: http://dx.doi.org/10.1007/s00068-018-0975-y .
     [Google Scholar]
  24. Bhullar IS, Tepas JJ, Siragusa D, Loper T, Kerwin A, Frykberg ER. To nearly come full circle: Nonoperative management of high-grade IV-V blunt splenic trauma is safe using a protocol with routine angioembolization. J Trauma Acute Care Surg. 2017; 82:(4):657–64.
     [Google Scholar]
  25. Leeper WR, Leeper TJ, Ouellette D, et al. Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma?: Early screening leads to a decrease in failure rate. J Trauma Acute Care Surg. 2014; 76:(6):1349–53.
     [Google Scholar]
  26. Davis KA, Fabian TC, Croce MA, et al. Improved success in nonoperative management of blunt splenic injuries: Embolization of splenic artery pseudoaneurysms. J Traumaa. 1998; 44::1008–15.
     [Google Scholar]
  27. Savage SA, Zarzaur BL, Magnotti LJ, et al. The evolution of blunt splenic injury: resolution and progression. J Trauma. 2008; 64:(4):1085–91.
     [Google Scholar]
  28. Zarzaur BL, Kozar RA, Fabian TC, Coimbra R. A survey of American Association for the Surgery of Trauma member practices in the management of blunt splenic injury. J Trauma. 2011; 70:(5):1026–31.
     [Google Scholar]
  29. Gannon EH, Howard T. Splenic injuries in athletes: A review. Curr Sports Med Rep. 2010; 9:(2):111–4.
     [Google Scholar]
  30. Teichman A, Scantling D, Mccracken B, Eakins J. Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective. Eur J Trauma Emerg Surg. 2018; 44::883-7.
     [Google Scholar]
  31. Brillantino A, Iacobellis F, Robustelli U, et al. Nonoperative management of blunt splenic trauma?: a prospective evaluation of a standardized treatment protocol. Eur J Trauma Emerg Surg. 2016; 42:(5):593-8.
     [Google Scholar]
  32. Saavedra ZM, Pérez AA, Pérez CB, et al. Management of splenic injuries utilizing a multidisciplinary protocol in 110 consecutive patients at a Level II hospital. Cir Esp. 2020; 98:(3):143–8.
     [Google Scholar]
  33. Wuthisuthimethawee P, Sookmee W, Damnoi S. Non-randomized comparative study on the efficacy of a trauma protocol in the emergency department. Chinese J Traumatol - English Ed [Internet]. 2019 May 29; 22:(4):207–11. Available from: https://doi.org/10.1016/j.cjtee.2019.04.003 .
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2021.22
Loading
Improving splenic conservation rate after trauma by applying a protocol for non-operative management and follow-up: A propensity-score analysis
Journal of Emergency Medicine, Trauma and Acute Care 2021, 22 (2021); https://doi.org/10.5339/jemtac.2021.22
/content/journals/10.5339/jemtac.2021.22
/content/journals/10.5339/jemtac.2021.22
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): non-operative management, non-operative management failure,, spleen trauma and trauma care

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error