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Jakob DA, Müller M, Kolitsas A, Exadaktylos AK, Demetriades D. Surgical Repair vs Splenectomy in Patients With Severe Traumatic Spleen Injuries. JAMA Netw Open 2024; 7:e2425300. [PMID: 39093564 PMCID: PMC11297384 DOI: 10.1001/jamanetworkopen.2024.25300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/02/2024] [Indexed: 08/04/2024] Open
Abstract
Importance The spleen is often removed in laparotomy after traumatic abdominal injury, with little effort made to preserve the spleen. Objective To explore the association of surgical management (splenic repair vs splenectomy) with outcomes in patients with traumatic splenic injuries undergoing laparotomy and to determine whether splenic repair is associated with lower mortality compared with splenectomy. Design, Setting, and Participants This is a trauma registry-based cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2019. Participants included adult patients with severe splenic injuries (Abbreviated Injury Scale [AIS] grades 3-5) undergoing laparotomy after traumatic injury within 6 hours of admission. Data analysis was performed from April to August 2023. Exposures Splenic repair vs splenectomy in patients with severe traumatic splenic injury. Main Outcomes and Measures The primary outcome was in-hospital mortality. Outcomes were compared using different statistical approaches, including 1:1 exact matching with consecutive conditional logistic regression analysis as the primary analysis and multivariable logistic regression, propensity score matching, and inverse-probability weighting as sensitivity analyses. Results A total of 11 247 patients (median [IQR] age, 35 [24-52] years; 8179 men [72.7%]) with a severe traumatic splenic injury undergoing laparotomy were identified. Of these, 10 820 patients (96.2%) underwent splenectomy, and 427 (3.8%) underwent splenic repair. Among patients who underwent an initial splenic salvage procedure, 23 (5.3%) required a splenectomy during the subsequent hospital stay; 400 patients with splenic preservation were matched with 400 patients who underwent splenectomy (matched for age, sex, hypotension, trauma mechanism, AIS spleen grade, and AIS groups [0-2, 3, and 4-5] for head, face, neck, thorax, spine, and lower and upper extremity). Mortality was significantly lower in the splenic repair group vs the splenectomy group (26 patients [6.5%] vs 51 patients [12.8%]). The association of splenic repair with lower mortality was subsequently verified by conditional regression analysis (adjusted odds ratio, 0.4; 95% CI, 0.2-0.9; P = .03). Multivariable logistic regression, propensity score matching, and inverse-probability weighting confirmed this association. Conclusions and Relevance In this retrospective cohort study, splenic repair was independently associated with lower mortality compared with splenectomy during laparotomy after traumatic splenic injury. These findings suggest that efforts to preserve the spleen might be indicated in selected cases of severe splenic injuries.
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Affiliation(s)
- Dominik A. Jakob
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles General Medical Center, University of Southern California, Los Angeles
- Department of Emergency Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Visceral Surgery, Lindenhofspital, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Apostolos Kolitsas
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles General Medical Center, University of Southern California, Los Angeles
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles General Medical Center, University of Southern California, Los Angeles
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Schild-Suhren S, Yilmaz E, Biggemann L, Seif A, Torsello GF, Uhlig A, Ghadimi M, Bösch F. [Management of Injuries to the Parenchymal Abdominal Organs]. Zentralbl Chir 2024; 149:359-367. [PMID: 38684170 DOI: 10.1055/a-2301-7951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
The most common organs affected by abdominal trauma are the spleen and the liver, often in combination. Pancreatic injuries are rare. In the case of blunt abdominal trauma, which is much more common, a clinical and laboratory examination as well as sonography should be performed. In the initial assessment, the circulatory situation must be screened. If there is haemodynamic instability and presentation of free fluid, an emergency laparotomy is indicated. If the situation is stable or stabilised and a pathological sonography is present, it is essential to perform triphasic contrast enhanced computed tomography, which is also mandatory in polytraumatised patients. If a renal injury is suspected, a late venous phase should be attached. In addition to the classification of the injury, attention should be paid to possible vascular injury or active bleeding. In this case, angiography with the possibility of intervention should be performed. Endoscopic treatment is possible for injuries of the pancreatic duct. If the imaging does not reveal any intervention target and a circulation is stable, a conservative approach is possible with continuous monitoring using clinical, laboratory and sonographic controls. Most injuries can be successfully treated by non-operative management (NOM).There are various surgical options for treating the injury, such as local and resecting procedures. There is also the option of "damage control surgery" with acute bleeding control and second look. Complex surgical procedures should be performed at centres. Postoperative complications arise out of elective surgery.In the less common case of penetrating abdominal trauma, the actual extent of the injury cannot be estimated from the visible wound. Here again, the circulatory situation determines the next steps. An emergency laparotomy should be carried out in case of instability. If the condition is stable, further diagnostics should be performed using contrast enhanced computed tomography. If penetration through the peritoneum cannot be clearly excluded, diagnostic laparoscopy should be performed.
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Affiliation(s)
- Stina Schild-Suhren
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Elif Yilmaz
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Lorenz Biggemann
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Ali Seif
- Institut für Diagnostische und Interventionelle Radiologie, Georg-August-Universität Göttingen, Gottingen, Deutschland
| | - Giovanni Federico Torsello
- Institut für Diagnostische und Interventionelle Radiologie, Georg-August-Universität Göttingen, Gottingen, Deutschland
| | - Annemarie Uhlig
- Klinik für Urologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Michael Ghadimi
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Florian Bösch
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
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Tang-Tan A, Chien CY, Park S, Schellenberg M, Lam L, Martin M, Inaba K, Matsushima K. Clinical factors and outcomes of spleen-conserving surgery versus total splenectomy in splenic injuries: A nationwide database study. Am J Surg 2024; 233:142-147. [PMID: 38490878 DOI: 10.1016/j.amjsurg.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The objective of this study was to identify factors associated with the use of spleen-conserving surgeries, as well as patient outcomes, on a national scale. METHODS This retrospective cohort study (2010-2015) included patients (age≥16 years) with splenic injury in the National Trauma Data Bank. Patients who received a total splenectomy or a spleen-conserving surgery were compared for demographics and clinical outcomes. RESULTS During the study period, 18,425 received a total splenectomy and 1,825 received a spleen-conserving surgery. Total splenectomy was more likely to be performed for patients with age>65 (odds ratio [OR]: 0.63, p < 0.001), systolic blood pressure<90 (OR: 0.63, p < 0.001), heart rate>120 (OR: 0.83, p = 0.007), and high-grade injuries (OR: 0.18, p < 0.001). Penetrating trauma patients were more likely to undergo a spleen-conserving surgery (OR: 3.31, p < 0.001). The use of spleen-conserving surgery was associated with a lower risk of pneumonia (OR: 0.79, p = 0.009) and venous thromboembolism (OR: 0.72, p = 0.006). CONCLUSIONS Spleen-conserving surgeries may be considered for patients with penetrating trauma, age<65, hemodynamic stability, and low-grade injuries. Spleen-conserving surgeries have decreased risk of pneumonia and venous thromboembolism.
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Affiliation(s)
- Angela Tang-Tan
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Chih Ying Chien
- Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd, Anle District, Keelung City, 204, Taiwan.
| | - Stephen Park
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Lydia Lam
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Matthew Martin
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Kenji Inaba
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Kazuhide Matsushima
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
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Ahmad MU, Lee D, Tennakoon L, Chao TE, Spain D, Staudenmayer K. Angioembolization for splenic injuries: does it help? Retrospective evaluation of grade III-V splenic injuries at two level I trauma centers. Trauma Surg Acute Care Open 2024; 9:e001240. [PMID: 38646615 PMCID: PMC11029436 DOI: 10.1136/tsaco-2023-001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Background Splenic angioembolization (SAE) has increased in utilization for blunt splenic injuries. We hypothesized lower SAE usage would not correlate with higher rates of additional intervention or mortality when choosing initial non-operative management (NOM) or surgery. Study design Trauma registries from two level I trauma centers from 2010 to 2020 were used to identify patients aged >18 years with grade III-V blunt splenic injuries. Results were compared with the National Trauma Data Bank (NTDB) for 2018 for level I and II centers. Additional intervention or failure was defined as any subsequent SAE or surgery. Mortality was defined as death during admission. Results There were 266 vs 5943 patients who met inclusion/exclusion criteria at Stanford/Santa Clara Valley Medical Center (SCVMC) versus the NTDB. Initial intervention differed significantly between cohorts with the use of SAE (6% vs 17%, p=0.000). Failure differed significantly between cohorts (1.5% vs 6.5%, p=0.005). On multivariate analysis, failure in NOM was significantly associated with NTDB cohort status, age 65+ years, more than one comorbidity, mechanism of injury, grade V spleen injury, and Injury Severity Score (ISS) 25+. On multivariate analysis, failure in SAE was significantly associated with Shock Index >0.9 and 10+ units blood in 24 hours. On multivariate analysis, a higher risk of mortality was significantly associated with NTDB cohort status, age 65+ years, no private insurance, more than one comorbidity, mechanism of injury, ISS 25+, 10+ units blood in 24 hours, NOM, more than one hospital complications, anticoagulant use, other Abbreviated Injury Scale ≥3 abdominal injuries. Conclusions Compared with national data, our cohort had less SAE, lower rates of additional intervention, and had lower risk-adjusted mortality. Shock Index >0.9, grade V splenic injuries, and increased transfusion requirements in the first 24 hours may signal a need for surgical intervention rather than SAE or NOM and may reduce mortality in appropriately selected patients. Level of evidence Level II/III.
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Affiliation(s)
- M Usman Ahmad
- Department of Surgery, Stanford University, Stanford, California, USA
| | - David Lee
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | | | - Tiffany Erin Chao
- Department of Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Santa Clara Valley Medical Center, San Jose, California, USA
| | - David Spain
- Department of Surgery, Stanford University, Stanford, California, USA
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Zouki J, Fry D. Partial Splenectomy and Splenic Wrapping for a High-Grade Splenic Injury: A Case Report. Cureus 2024; 16:e54372. [PMID: 38371437 PMCID: PMC10874609 DOI: 10.7759/cureus.54372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 02/20/2024] Open
Abstract
The spleen is one of the most commonly injured organs in blunt abdominal trauma, accounting for a vast portion of solid organ injuries, and may lead to rapid haemodynamic instability, requiring urgent operative intervention. Total splenectomies result in relative immunocompromise, with a risk of overwhelming post-splenectomy infection (OPSI) post splenectomy. This case reports the surgical management of a 20-year-old male with a grade IV splenic laceration after a motor vehicle accident. The patient underwent a trauma laparotomy with a partial splenectomy because of early take-off of the upper-lobar branch of his splenic artery, with an absorbable mesh wrap to tamponade the spleen. The patient avoided the need for a total splenectomy and was discharged after six days in the hospital with an uncomplicated recovery.
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Affiliation(s)
- Jason Zouki
- General Surgery, Toowoomba Hospital, Toowoomba, AUS
| | - Damian Fry
- General Surgery, Darling Downs Hospital and Health Service, Toowoomba, AUS
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Atkins K, Schneider A, Charles A. Splenic Salvage: Is There a Role for Splenorrhaphy in the Management of Adult Splenic Trauma? Am Surg 2023; 89:5599-5608. [PMID: 36878857 DOI: 10.1177/00031348231156760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Nonoperative management of splenic injuries is recommended. Total splenectomy is the primary operative management, and the current role of splenorrhaphy in splenic salvage is not well delineated. METHODS We reviewed the National Trauma Data Bank (2007-2019) for adult splenic injuries. Operative splenic injury management were compared. We performed bivariate analysis and multivariable logistic regression to estimate the effect of surgical management on mortality. RESULTS 189,723 patients met the inclusion criteria. Splenic injury management was stable, with 18.2% undergoing a total splenectomy and 1.9% splenorrhaphy. Splenorrhaphy patients had lower crude mortality (2.7% vs 8.3%, P < .001) than total splenectomy patients. Failed splenorrhaphy patients had higher crude mortality (10.1% vs 8.3%, P < .001) than patients who underwent initial total splenectomy. Patients who underwent total splenectomy had an adjusted odd of 2.30 (95% CI 1.82-2.92, P < .001) for mortality compared to successful splenorrhaphy. Patients who failed splenorrhaphy had an adjusted odd of 2.36 (95% CI 1.19-4.67, P < .014) for mortality compared to successful splenorrhaphy. CONCLUSION Adults with splenic injuries requiring operative intervention have twice the odds of mortality when a total splenectomy is performed or when splenorrhaphy fails compared to successful splenorrhaphy.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Toti JMA, Gatti B, Hunjan I, Kottanattu L, Faré PB, Renzi S, Bianchetti MG, Milani GP, Lava SAG, Camozzi P. Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review. Swiss Med Wkly 2023; 153:40081. [PMID: 37245117 DOI: 10.57187/smw.2023.40081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV), also known as human herpesvirus 4, is one of the most common pathogenic viruses in humans. EBV mononucleosis always involves the spleen and as such it predisposes to splenic rupture, often without a trauma, and splenic infarction. Nowadays the goal of management is to preserve the spleen, thereby eliminating the risk of post-splenectomy infections. METHODS To characterise these complications and their management, we performed a systematic review (PROSPERO CRD42022370268) following PRISMA guidelines in three databases: Excerpta Medica, the United States National Library of Medicine, and Web of Science. Articles listed in Google Scholar were also considered. Eligible articles were those describing splenic rupture or infarction in subjects with Epstein-Barr virus mononucleosis. RESULTS In the literature, we found 171 articles published since 1970, documenting 186 cases with splenic rupture and 29 with infarction. Both conditions predominantly occurred in males, 60% and 70% respectively. Splenic rupture was preceded by a trauma in 17 (9.1%) cases. Approximately 80% (n = 139) of cases occurred within three weeks of the onset of mononucleosis symptoms. A correlation was found between the World Society of Emergency Surgery splenic rupture score, which was retrospectively calculated, and surgical management: splenectomy in 84% (n = 44) of cases with a severe score and in 58% (n = 70) of cases with a moderate or minor score (p = 0.001). The mortality rate of splenic rupture was 4.8% (n = 9). In splenic infarction, an underlying haematological condition was observed in 21% (n = 6) of cases. The treatment of splenic infarction was always conservative without any fatal outcomes. CONCLUSIONS Similarly to traumatic splenic rupture, splenic preservation is increasingly common in the management of mononucleosis-associated cases as well. This complication is still occasionally fatal. Splenic infarction often occurs in subjects with a pre-existing haematological condition.
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Affiliation(s)
- Johannes M A Toti
- Department of Surgery and Transplantation, University Hospital Zurich Zurich, Switzerland
| | - Beatrice Gatti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Isabella Hunjan
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro B Faré
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Samuele Renzi
- Division of Hematology and Oncology, CHUL-Laval, Quebec City, Canada
- Department of Pediatrics, Laval University, Quebec City, Canada
| | - Mario G Bianchetti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Heart Failure and Transplantation, Department of Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
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Schild-Suhren S, Zygmunt AC, Biggemann L, Hosseini ASA, Ghadimi M, Bösch F. [Treatment recommendation and care in traumatic rupture of the spleen]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01873-2. [PMID: 37115223 DOI: 10.1007/s00104-023-01873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/29/2023]
Abstract
The spleen is the most frequently affected organ in blunt abdominal trauma. Initial diagnostics include the physical examination, laboratory blood controls and ultrasound. Furthermore, a triphasic dynamic contrast-enhanced computed tomography (CT) scan is indicated. Apart from the imaging-based classification of the injury with consideration of vascular alterations and active bleeding, the hemodynamic condition of the patient is a crucial factor. For patients who are hemodynamically stable or can be stabilized, a nonoperative management with a minimum of 24 h of continuous monitoring, regular blood controls of the hemoglobin level as well as ultrasound follow-up should be given precedence. In cases of active bleeding or pathological vascular alterations, a radiological intervention in the sense of an embolization should be initiated. A hemodynamically unstable patient must immediately undergo surgical treatment, during which a spleen-preserving approach via splenorrhaphy should principally be favored over splenectomy. This also applies to patients where the intervention has failed. To prevent severe infections after splenectomy it is advised to vaccinate against Pneumococcus, Haemophilus influenzae type B and Meningococcus as well as the annual seasonal influenza vaccination according to the Standing Committee on Vaccination (STIKO) recommendations.
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Affiliation(s)
- Stina Schild-Suhren
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Anne-Christine Zygmunt
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Lorenz Biggemann
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Ali Seif Amir Hosseini
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Michael Ghadimi
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Florian Bösch
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Feliciano DV. 2022 Excelsior Surgical Society/Edward D Churchill Lecture: Extraordinary Evolution of Surgery for Abdominal Trauma. J Am Coll Surg 2023; 236:439-448. [PMID: 36730657 DOI: 10.1097/xcs.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- David V Feliciano
- From the Shock Trauma Center/Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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10
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Management and Outcome of High-Grade Hepatic and Splenic Injuries. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Feliciano DV. Trauma: The most progressive subspecialty of all. J Trauma Acute Care Surg 2023; 94:8-14. [PMID: 36221176 DOI: 10.1097/ta.0000000000003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- David V Feliciano
- From the University of Maryland School of Medicine; Shock Trauma Center/Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
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