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Zenaidi H, Ismail IB, Rebii S, Zoghlami A. Predictors of Failure of Nonoperative Management in Spleen Trauma. J Emerg Trauma Shock 2020; 13:319-320. [PMID: 33897154 PMCID: PMC8047952 DOI: 10.4103/jets.jets_60_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/25/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hakim Zenaidi
- Department of General Surgery, Traumatology and Severe Burns Center, Ben Arous, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Ben Ismail
- Department of General Surgery, Traumatology and Severe Burns Center, Ben Arous, University of Tunis El Manar, Tunis, Tunisia
| | - Saber Rebii
- Department of General Surgery, Traumatology and Severe Burns Center, Ben Arous, University of Tunis El Manar, Tunis, Tunisia
| | - Ayoub Zoghlami
- Department of General Surgery, Traumatology and Severe Burns Center, Ben Arous, University of Tunis El Manar, Tunis, Tunisia
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Salottolo K, Madayag RM, O'Brien M, Yon J, Tanner A, Topham A, Lieser M, Carrick MM, Mains CW, Bar-Or D. Quantity of hemoperitoneum is associated with need for intervention in patients with stable blunt splenic injury. Trauma Surg Acute Care Open 2020; 5:e000406. [PMID: 32154378 PMCID: PMC7046947 DOI: 10.1136/tsaco-2019-000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/27/2019] [Accepted: 12/23/2019] [Indexed: 11/03/2022] Open
Abstract
Background In patients with hemodynamically stable blunt splenic injury (BSI), there is no consensus on whether quantity of hemoperitoneum (HP) is a predictor for intervention with splenic artery embolization (SAE) or failing nonoperative management (fNOM). We sought to analyze whether the quantity of HP was associated with need for intervention. Methods This retrospective cohort study included adult trauma patients with hemodynamically stable BSI admitted to six trauma centers between 2014 and 2016. Quantity of HP was defined as small (perisplenic blood or blood in Morrison's pouch), moderate (blood in one or both pericolic gutters), or large (additional finding of free blood in the pelvis). Multivariate logistic regression was performed to identify predictors of intervention with SAE or fNOM versus successful observation. Results There were 360 patients: hemoperitoneum was noted in 214 (59%) patients, of which the quantity was small in 92 (43%), moderate in 76 (35.5%), and large in 46 (21.5%). Definitive management was as follows: 272 (76%) were observed and 88 (24%) had intervention (83 SAE, 5 fNOM). The rate of intervention was univariately associated with quantity of HP, even after stratification by American Association for the Surgery of Trauma (AAST) grade. After adjustment, larger quantities of HP significantly increased odds of intervention (p=0.01). Compared with no HP, the odds of intervention were significantly increased for moderate HP (OR=3.51 (1.49 to 8.26)) and large HP (OR=2.89 (1.03 to 8.06)), with similar odds for small HP (OR=1.21 (0.46 to 2.76)). Other independent predictors of intervention were higher AAST grade, older age, and presence of splenic vascular injury. Conclusion Greater quantity of HP was associated with increased odds of intervention, with no difference in risk for moderate versus large HP. These findings suggest quantity of HP should be incorporated in the management algorithm of BSI as a consideration for angiography and/or embolization to maximize splenic preservation and reduce the risk of splenic rupture. Level of evidence III, retrospective epidemiological study.
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Affiliation(s)
- Kristin Salottolo
- Trauma Research, Swedish Medical Center, Englewood, Colorado, USA.,St. Anthony Hospital, Lakewood, Colorado, USA.,Penrose-St. Francis Health Services, Colorado Springs, Colorado, USA.,Radiology, Wesley Medical Center Trauma Services, Wichita, Kansas, USA.,Trauma Services, Research Medical Center, Kansas City, Missouri, USA.,Medical Center of Plano, Plano, Texas, USA
| | | | - Michael O'Brien
- Penrose-St. Francis Health Services, Colorado Springs, Colorado, USA
| | - James Yon
- Trauma Research, Swedish Medical Center, Englewood, Colorado, USA
| | - Allen Tanner
- Penrose-St. Francis Health Services, Colorado Springs, Colorado, USA
| | - Andrew Topham
- Radiology, Wesley Medical Center Trauma Services, Wichita, Kansas, USA
| | - Mark Lieser
- Trauma Services, Research Medical Center, Kansas City, Missouri, USA
| | | | | | - David Bar-Or
- Trauma Research, Swedish Medical Center, Englewood, Colorado, USA.,St. Anthony Hospital, Lakewood, Colorado, USA.,Penrose-St. Francis Health Services, Colorado Springs, Colorado, USA.,Radiology, Wesley Medical Center Trauma Services, Wichita, Kansas, USA.,Trauma Services, Research Medical Center, Kansas City, Missouri, USA.,Medical Center of Plano, Plano, Texas, USA
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Markert K, Haltmeier T, Khatsilouskaya T, Keel MJ, Candinas D, Schnüriger B. Early Surgery in Prone Position for Associated Injuries in Patients Undergoing Non-operative Management for Splenic and Liver Injuries. World J Surg 2018; 42:3947-3953. [DOI: 10.1007/s00268-018-4739-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Van der Cruyssen F, Manzelli A. Splenic artery embolization: technically feasible but not necessarily advantageous. World J Emerg Surg 2016; 11:47. [PMID: 27625701 PMCID: PMC5020467 DOI: 10.1186/s13017-016-0100-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/11/2016] [Indexed: 11/16/2022] Open
Abstract
Background The 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 literature Through 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. Conclusions NOM+ 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 material The 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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Affiliation(s)
- F Van der Cruyssen
- Third year master's student, Faculty of Medicine, Catholic University of Leuven (KU Leuven), Gasthuisberg, Belgium
| | - A Manzelli
- Department of Upper Gastrointestinal Surgery, Royal Devon & Exeter Hospital, Exeter, UK
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Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 2013; 74:546-57. [PMID: 23354249 DOI: 10.1097/ta.0b013e31827d5e3a] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or without angiography and embolization. METHODS MEDLINE, Embase, and the Cochrane Library databases were searched. Prospective or retrospective cohort studies addressing failure of nonoperative treatment, with and/or without angiography and embolization, of blunt abdominal injuries were included. Methodological quality of the studies was assessed. RESULTS A total of 335 titles and abstracts were screened, of which 31 fulfilled the inclusion criteria. No randomized controlled trials were found. Ten articles were qualified as high-quality articles and used for data extraction (best-evidence synthesis). A total of 25 prognostic factors were investigated, of which 14 were statistically significant in one or more studies. Strong evidence exists that age of 40 years or above, Injury Severity Score (ISS) of 25 or greater, and splenic injury grade of 3 or greater are prognostic factors for failure of NOM. Moderate evidence was found for a splenic Abbreviated Injury Scale score of 3 or greater, trauma and ISS of less than 0.80, the presence of an intraparenchymal contrast blush, as well as transfusion of 1 unit of packed red blood cells or more. Limited evidence was found for large hemoperitoneum, lower Revised Trauma Score, lower Glasgow Coma Scale score, lower systolic blood pressure, male sex, the presence of traumatic brain injury, and splenic embolization as protective factor for failure of NOM. CONCLUSION Awareness for failure of NOM is required in patients aged 40 years or older, in patients with an ISS of 25 or higher or those with splenic injury grade 3 or higher. The prognostic factors for failure that we identified should be confirmed in future prospective cohort studies or meta-analyses using individual patient data. LEVEL OF EVIDENCE Systematic review, level III.
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Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs. Int J Emerg Med 2011; 4:47. [PMID: 21794108 PMCID: PMC3170179 DOI: 10.1186/1865-1380-4-47] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/27/2011] [Indexed: 11/29/2022] Open
Abstract
Background In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization. Aim The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney. Results The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the literature is whether a whole body MDCT survey should be implemented in the primary survey.
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Le Moine MC, Aguilar E, Vacher C, Passebois L, Bono D, Guillon F, Marchand JP, Pirlet I, Forestier D, Rubay R, Toporov N, Carbonel G, Prudhomme M. Splenic injury: management in the Languedoc-Roussillon region. J Visc Surg 2011; 147:e247-52. [PMID: 20889392 DOI: 10.1016/j.jviscsurg.2010.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
GOAL OF STUDY Treatment of splenic injury is not standardized. We conducted an inventory of splenic injury treatment modalities of splenic injury in the Languedoc-Roussillon region of France. METHODS A questionnaire was sent by e-mail to 33 surgeons practicing in 10 hospitals in that region. Surgeons were asked: how many cases were treated per year (PMSI databank for the last three years), local resources (resuscitation bay or intensive care unit, availability of CT and interventional radiology), indications (surgery, embolization, nonoperative management [NOM]), prognostic criteria, NOM modalities (duration of bed rest, hospital stay, restriction of physical activity, thromboembolic prophylaxis, and imaging schedule). RESULTS Thirty-one surgeons replied. An average of 185 patients were treated per year. There was consensus concerning the indication for urgent splenectomy, NOM was practiced in the stable patient (even with diffuse hemoperitoneum) and splenic artery embolization was performed for active bleeding (blush on CT) (for the six centers who have interventional radiology at their disposal). Disparities existed between centers concerning the modalities of NOM excepting imaging monitoring, initial surveillance in resuscitation bay or intensive care and in the therapeutic indications when bleeding persisted. CONCLUSION Based on the consensus observed in this study and an analysis of the literature, a uniform treatment policy can be proposed.
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Affiliation(s)
- M-C Le Moine
- Service de Chirurgie Digestive et Cancérologie, Centre Hospitalier Carémeau, Place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France.
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Renzulli P, Gross T, Schnüriger B, Schoepfer AM, Inderbitzin D, Exadaktylos AK, Hoppe H, Candinas D. Management of blunt injuries to the spleen. Br J Surg 2010; 97:1696-703. [DOI: 10.1002/bjs.7203] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Non-operative management (NOM) of blunt splenic injuries is nowadays considered the standard treatment. The present study identified selection criteria for primary operative management (OM) and planned NOM.
Methods
All adult patients with blunt splenic injuries treated at Berne University Hospital, Switzerland, between 2000 and 2008 were reviewed.
Results
There were 206 patients (146 men) with a mean(s.d.) age of 38·2(19·1) years and an Injury Severity Score of 30·9(11·6). The American Association for the Surgery of Trauma classification of the splenic injury was grade 1 in 43 patients (20·9 per cent), grade 2 in 52 (25·2 per cent), grade 3 in 60 (29·1 per cent), grade 4 in 42 (20·4 per cent) and grade 5 in nine (4·4 per cent). Forty-seven patients (22·8 per cent) required immediate surgery. Transfusion of at least 5 units of red cells (odds ratio (OR) 13·72, 95 per cent confidence interval 5·08 to 37·01), Glasgow Coma Scale score below 11 (OR 9·88, 1·77 to 55·16) and age 55 years or more (OR 3·29, 1·07 to 10·08) were associated with primary OM. The rate of primary OM decreased from 33·3 to 11·9 per cent after the introduction of transcatheter arterial embolization in 2005. Overall, 159 patients (77·2 per cent) qualified for NOM, which was successful in 143 (89·9 per cent). The splenic salvage rate was 69·4 per cent. In multivariable analysis age at least 40 years was the only factor independently related to failure of NOM (OR 13·58, 2·76 to 66·71).
Conclusion
NOM of blunt splenic injuries has a low failure rate. Advanced age is independently associated with an increased failure rate.
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Affiliation(s)
- P Renzulli
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland
| | - T Gross
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland
| | - B Schnüriger
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland
- Department of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California, USA
| | - A M Schoepfer
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland
- Farncombe Family Institute of Digestive Health Research, McMaster University, Hamilton, Ontario, Canada
| | - D Inderbitzin
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland
| | - A K Exadaktylos
- Department of Emergency Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland
| | - H Hoppe
- Department of Diagnostic Radiology, Inselspital, Berne University Hospital, and University of Berne, Switzerland
| | - D Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland
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Abstract
The nonoperative care of intraabdominal trauma in the polytraumatised patient greatly depends on imaging techniques. The haemodynamically unstable patient should undergo expedient sonography to rule out abdominal haemorrhage. The use of computer tomography (CT) in this difficult patient group is also currently evaluated, however it takes specific amendments to the protocol and institution. In the hemodynamically stable patient however, computer tomography is the modality of choice to evaluate the injured abdomen. Nonoperative treatment can be successful in up to 80% of selected cases. Adjuncts to nonoperative care include embolisation of the spleen and liver in cases of arterial bleeding, and endoscopic retrograde cholangio pancreaticography (ERCP) and stenting for injuries to the biliary tree.
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Affiliation(s)
- Luke P H Leenen
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
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Arvieux C. Traitement non-opératoire des traumatismes fermés de la rate chez l’adulte. ACTA ACUST UNITED AC 2008; 145:531. [DOI: 10.1016/s0021-7697(08)74682-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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