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Alomar Z, Alomar Y, Mahmood I, Alomar A, El-Menyar A, Asim M, Rizoli S, Al-Thani H. Complications and failure rate of splenic artery angioembolization following blunt splenic trauma: A systematic review. Injury 2024; 55:111753. [PMID: 39111269 DOI: 10.1016/j.injury.2024.111753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Over recent decades, splenic angioembolization (SAE) as an adjunct to non-operative management (NOM) has emerged as a prominent intervention for patients with blunt splenic injuries (BSI). SAE improves patient outcomes, salvages the spleen, and averts complications associated with splenectomy. This systematic review aimed to evaluate the failure rate and complications related to SAE in patients with BSI. METHODS A systematic literature search (PubMed, SCOPUS, and Cochrane Library) focused on studies detailing splenic angioembolization in blunt trauma cases. Articles that fulfilled the predetermined inclusion criteria were included. This review examined the indications, outcomes, failure rate, and complications of SAE. RESULTS Among 599 identified articles, 33 met the inclusion criteria. These comprised 29 retrospective studies, three prospective studies, and one randomized control trial. The analysis encompassed 25,521 patients admitted with BSI and 3,835 patients who underwent SAE. The overall failure rate of SAE was 5.3 %. Major complications predominantly were rebleeding (4.8 %), infarction (4.6 %), and abscess formation (4 %). Minor complications were fever (18.4 %), pleural effusion (13.1 %), and coil migration (3.9 %). Other complications included splenic atrophy, splenic cyst, hematoma, and access site complications such as splenic/femoral dissection. Overall, post embolization mortality was 0.08 %. CONCLUSION SAE is a valuable adjunct in managing BSI, with a low failure rate. However, this treatment modality is not without the risk of potentially serious complications.
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Affiliation(s)
- Zubaidah Alomar
- Jordan University of Science and Technology (Student), Jordan
| | - Yousif Alomar
- Jordan University of Science and Technology (Student), Jordan
| | | | - Ali Alomar
- Jordan University of Science and Technology (Student), Jordan
| | - Ayman El-Menyar
- Trauma Surgery, Hamad Medical Corporation Qatar; Internal Medicine, Weill Cornell Medicine, Qatar.
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Kumar P, Singh A, Triveni GS, Chandrashekhara SH, Gamanagatti S, Nichat V. Celiac trunk arterial variations and their clinical implications: Role of imaging. Indian J Gastroenterol 2024:10.1007/s12664-024-01656-5. [PMID: 39243342 DOI: 10.1007/s12664-024-01656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 07/23/2024] [Indexed: 09/09/2024]
Abstract
The awareness of anatomical variations of hepatic arteries and celiac trunk is very important in interventional radiology, liver transplant and intra-abdominal oncologic surgeries. Radiology plays an important role in the identification of these variants non-invasively. Digital subtraction angiography was the gold standard for their identification. Computed tomography (CT) angiography non-invasively provides detailed knowledge of various anatomical vascular variations. This pictorial review highlights the role of multidetector computed tomography (MDCT) in the identification of celiac trunk-hepatic arterial system variations and clinical consequences.
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Affiliation(s)
- Pawan Kumar
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Anuradha Singh
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - G S Triveni
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Delhi, 110 001, India
| | - S H Chandrashekhara
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India.
| | - Shivanand Gamanagatti
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Vaibhav Nichat
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
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Follette C, Roeber HL, Lombana GR, Simas MA, Alvarado SM, McCullough MA, Hildreth AN, Miller PR, Avery MD. Standardizing quality utilization of interventional radiology treatments of blunt splenic injury: SQUIRTS study. Injury 2024; 55:111707. [PMID: 38942724 DOI: 10.1016/j.injury.2024.111707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/25/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVES Nonoperative management (NOM) of blunt splenic injury (BSI) is well accepted in appropriate patients. Splenic artery embolization (SAE) in higher-grade injuries likely plays an important role in increasing the success of NOM. We previously implemented a protocol requiring referral of all BSI grades III-V undergoing NOM for SAE. It is unknown the risk of complications as well as longitudinal outcomes. We aimed to examine the splenic salvage rate and safety profile of the protocol. We hypothesized the splenic salvage rate would be high and complications would be low. METHODS A retrospective study was performed at our Level 1 trauma center over a 9-year period. Injury characteristics and outcomes in patients sustaining BSI grades III-V were collected. Outcomes were compared for NOM on protocol (SAE) and off protocol (no angiography or angiography but no embolization). Complications for angiographies were examined. RESULTS Between January 2010 and February 2019, 570 patients had grade III-V BSI. NOM was attempted in 359 (63 %) with overall salvage rate of 91 % (328). Of these, 305 were on protocol while 54 were off protocol (41 no angiography and 13 angiography but no SAE). During the study period, for every grade of injury a pattern was seen of a higher salvage rate in the on-protocol group when compared to the off-protocol group (Grade III, 97 %(181/187) vs. 89 %(32/36), Grade IV, 91 %(98/108) vs. 69 %(9/13) and Grade V, 80 %(8/10 vs. 0 %(0/5). The overall salvage rate was 94 %(287) on protocol vs. 76 %(41) off protocol (p < 0.001, Cochran-Mantel-Haenszel test). Complications occurred in only 8 of the 318 who underwent angiography (2 %). These included 5 access complications and 3 abscesses. CONCLUSION The use of a protocol requiring routine splenic artery embolization for all high-grade spleen injuries slated for non-operative management is safe with a very low complication rate. NOM with splenic angioembolization failure rate is improved as compared to non-SAE patients' at all higher grades of injury. Thus, SAE for all hemodynamically stable patients of all high-grade types should be considered as a primary form of therapy for such injuries.
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Affiliation(s)
- Craig Follette
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Heidi L Roeber
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Gregory R Lombana
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Madison A Simas
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Sophia M Alvarado
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Mary Alyce McCullough
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Amy N Hildreth
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Preston R Miller
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Martin D Avery
- Department of Surgery, Atrium Health Wake Forest Baptist University Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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Hamghalam M, Moreland R, Gomez D, Simpson A, Lin HM, Jandaghi AB, Tafur M, Vlachou PA, Wu M, Brassil M, Crivellaro P, Mathur S, Hosseinpour S, Colak E. Machine Learning Detection and Characterization of Splenic Injuries on Abdominal Computed Tomography. Can Assoc Radiol J 2024; 75:534-541. [PMID: 38189316 DOI: 10.1177/08465371231221052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Multi-detector contrast-enhanced abdominal computed tomography (CT) allows for the accurate detection and classification of traumatic splenic injuries, leading to improved patient management. Their effective use requires rapid study interpretation, which can be a challenge on busy emergency radiology services. A machine learning system has the potential to automate the process, potentially leading to a faster clinical response. This study aimed to create such a system. METHOD Using the American Association for the Surgery of Trauma (AAST), spleen injuries were classified into 3 classes: normal, low-grade (AAST grade I-III) injuries, and high-grade (AAST grade IV and V) injuries. Employing a 2-stage machine learning strategy, spleens were initially segmented from input CT images and subsequently underwent classification via a 3D dense convolutional neural network (DenseNet). RESULTS This single-centre retrospective study involved trauma protocol CT scans performed between January 1, 2005, and July 31, 2021, totaling 608 scans with splenic injuries and 608 without. Five board-certified fellowship-trained abdominal radiologists utilizing the AAST injury scoring scale established ground truth labels. The model achieved AUC values of 0.84, 0.69, and 0.90 for normal, low-grade injuries, and high-grade splenic injuries, respectively. CONCLUSIONS Our findings demonstrate the feasibility of automating spleen injury detection using our method with potential applications in improving patient care through radiologist worklist prioritization and injury stratification. Future endeavours should concentrate on further enhancing and optimizing our approach and testing its use in a real-world clinical environment.
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Affiliation(s)
- Mohammad Hamghalam
- School of Computing and Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Electrical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Robert Moreland
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - David Gomez
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Amber Simpson
- School of Computing and Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Hui Ming Lin
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Ali Babaei Jandaghi
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Monica Tafur
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Paraskevi A Vlachou
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Matthew Wu
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael Brassil
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Priscila Crivellaro
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shobhit Mathur
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Shahob Hosseinpour
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Errol Colak
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
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Huang JF, Wang CC, Shen SY, Fu CY, Hsu CP, Cheng CT, Liao CA, Kuo LW, Ou Yang CH, Liao CH. Feasibility of non-operative management for patients sustained blunt splenic traumas with concomitant aortic injuries. Eur J Trauma Emerg Surg 2024; 50:809-820. [PMID: 38097784 DOI: 10.1007/s00068-023-02403-9] [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: 09/22/2023] [Accepted: 11/09/2023] [Indexed: 07/16/2024]
Abstract
PURPOSE This study aimed to elucidate the treatment approach for blunt splenic injuries concurrently involving the aorta. We hypothesized that non-operative management failure rates would be higher in such cases, necessitating increased hemorrhage control surgeries. METHODS Data from the Trauma Quality Improvement Program spanning 2017 to 2019 were utilized. All patients with blunt splenic trauma were considered for inclusion. We conducted comparisons between blunt splenic trauma patients with and without thoracic or abdominal aortic injuries to identify any potential disparities in treatment. RESULTS Among the 32,051 patients with blunt splenic injuries during the study period, 752 (2.3%) sustained concurrent aortic injuries. Following 2:1 propensity score matching, it was determined that the presence of aortic injuries did not significantly affect the utilization of splenic transarterial angioembolization (TAE) (7.2% vs. 8.7%, p = 0.243) or the necessity for splenectomy or splenorrhaphy (15.3% vs. 15.7%, p = 0.853). Moreover, aortic injuries were not a significant factor contributing to TAE failure, regardless of the location or severity of the injury. Patients with simultaneous splenic and aortic injuries required more red blood cell transfusion within first 4 hours (0 ml [0, 900] vs. 0 ml [0, 650], p = 0.001) and exhibited a higher mortality rate (10.6% vs. 7.9%, p = 0.038). CONCLUSION This study demonstrated that patients with concurrent aortic and splenic injuries presented with more severe conditions, higher mortality rates, and extended hospital stays. The presence of aortic injuries did not substantially influence the utilization of TAE or the necessity for splenectomy or splenorrhaphy. Patients of this type can be managed in accordance with current treatment guidelines. Nonetheless, given their less favorable prognosis, they necessitate prompt and proactive intervention.
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Affiliation(s)
- Jen-Fu Huang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Chia-Cheng Wang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Shu-Yueh Shen
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan.
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan.
| | - Chih-Po Hsu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Chien-An Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Chun-Hsiang Ou Yang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
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Al Jabri A, Al Masrouri S, Al Adawi H, Al Qadhi H. Colosplenic Fistula Following Splenic Embolization in a Sickle Cell Disease Patient. Cureus 2024; 16:e61011. [PMID: 38800766 PMCID: PMC11125456 DOI: 10.7759/cureus.61011] [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: 05/24/2024] [Indexed: 05/29/2024] Open
Abstract
This case report details a rare instance of a colosplenic fistula following splenic embolization in a patient with sickle cell disease. The patient, a 29-year-old female, presented with symptoms of left hypochondrial pain and fever. Imaging revealed a splenic abscess characterized by an air-fluid level. Intraoperative observations disclosed that the spleen was entirely replaced by an abscess cavity, with the presence of colosplenic fistulae. A splenectomy and colonic resection were performed. This report highlights a rare complication that occurred a long time after splenic embolization, underscoring the need for a high level of suspicion to prevent serious complications.
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Affiliation(s)
| | | | | | - Hani Al Qadhi
- Surgery, Sultan Qaboos University Hospital, Muscat, OMN
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Lokuhetty N, Philip MT, Paynter JA, Owen AR. A case report of successful splenic artery embolization for atraumatic splenic rupture secondary to Epstein Barr virus infection in a haemodynamically unstable patient. Radiol Case Rep 2024; 19:1970-1974. [PMID: 38434780 PMCID: PMC10909597 DOI: 10.1016/j.radcr.2024.02.016] [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: 10/10/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Splenic rupture in haemodynamically unstable patients has traditionally been managed with splenectomy. This case report discusses the successful management of atraumatic splenic rupture, a rare but life-threatening complication of Epstein-Barr virus (EBV) infection, in a hemodynamically unstable patient. The patient, diagnosed with infectious mononucleosis (IM) secondary to EBV, presented with severe abdominal pain and a syncopal episode. Imaging revealed an American Association for the Surgery of Trauma (AAST) grade III splenic injury, which was subsequently upgraded to a grade IV injury on repeat imaging. The patient's condition deteriorated even with initial resuscitation, leading to splenic angioembolization. The procedure was successful and the patient was discharged after 5 days. This case highlights the efficacy of splenic artery embolization (SAE) in haemodynamically unstable patients with atraumatic splenic rupture, particularly in centers with interventional radiology resources, offering an alternative to splenectomy and its associated complications.
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Mahmood I, Younis B, Alabdallat M, Mathradikkal S, Abdelrahman H, El-Menyar A, Asim M, Kasim M, Mollazehi M, Al-Hassani A, Peralta R, Rizoli S, Al-Thani H. Pre- and post-implementation protocol for non-operative management of grade III-V splenic injuries: An observational study. Heliyon 2024; 10:e28447. [PMID: 38560121 PMCID: PMC10979267 DOI: 10.1016/j.heliyon.2024.e28447] [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] [Received: 07/19/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Grade (III-V) blunt splenic injuries (BSI) in hemodynamically stable patients represent clinical challenges for successful non-operative management (NOM). In 2014, Our institution proposed a treatment protocol requiring splenic angiography and embolization for stable, intermediate, and high-grade BSI. It also included a follow-up CT scan for grade III BSI. We sought to assess the success rate of NOM in treating intermediate and high-grade BSI, following a standardized treatment protocol at a level 1 trauma center. Methods An observational retrospective study was conducted. Data of patients with BSI from June 2011 to September 2019 were reviewed using the Qatar National Trauma Registry. Patients' demographics, CT scan and angiographic findings, grade of splenic injuries, and outcomes were analyzed. The pre- and post-implementation of treatment protocol periods were compared. Results During the study period, a total of 552 hemodynamically stable patients with BSI were admitted, of which 240 had BSI with grade III to V. Eighty-one patients (33.8%) were admitted in the pre-protocol implementation period and 159 (66.2%) in the post-protocol implementation period. The NOM rate increased from 50.6% in the pre-protocol group to 65.6% in the post-protocol group (p = 0.02). In addition, failure of the conservative treatment did not significantly differ in the two periods, while the requirement for blood transfusion dropped from 64.2% to 45.9% (p = 0.007). The frequency of CT scan follow-up (55.3% vs. 16.3%, p = 0.001) and splenic arterial embolization (32.7% vs. 2.5%, p = 0.001) in NOM patients increased significantly in the post-protocol group compared to the pre-protocol group. Overall mortality was similar between the two periods. However, hospital and ICU length of stay and ventilatory days were higher in the post-protocol group. Conclusions NOM is an effective and safe treatment option for grade III-V BSI patients. Using standardized treatment guidelines for intermediate-to high-grade splenic injuries could increase the success rate for NOM and limit unnecessary laparotomy. Moreover, angioembolization is a crucial adjunct to NOM that could improve the success rate.
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Affiliation(s)
- Ismail Mahmood
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Basil Younis
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohammad Alabdallat
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Saji Mathradikkal
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, HMC, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, HMC, Doha, Qatar
| | - Mohammad Kasim
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, National Trauma Registry, HMC, Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, HMC, Doha, Qatar
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9
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Kumar S, Katiyar V, Sharma S, Srivastava VK, Bhartiya SK, Mishra SP. A Clinical Review and Experience of Splenic Trauma in North India: A Retrospective Observational Study. Cureus 2024; 16:e55384. [PMID: 38562336 PMCID: PMC10984127 DOI: 10.7759/cureus.55384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The spleen is one of the frequently injured solid organs in abdominal blunt trauma. The standard of care is nonoperative nowadays depending on the hemodynamic stability (World Society of Emergency Surgery (WSES) grade I-III) of the patient due to advancements in treating modalities. Operative interventions are required in hemodynamically unstable patients or failure of nonoperative management. The study was planned to find the clinical spectrum of abdominal blunt trauma, specifically those having splenic trauma, and their subsequent management in an institution. METHODS This is a retrospective observational study. All included patients with blunt abdominal injuries were treated in a level 1 trauma center between July 2021 and December 2022. Data regarding demographic profile, blood transfusion, pre- and postoperative findings, and management including the period of hospital stay, morbidity, and mortality were collected and analyzed. RESULTS One hundred sixty-four patients were analyzed, of which 142 were males and 22 were females. The commonest mechanism of injury was motor vehicle collision, followed by falls. Grade III splenic injury was the most common injury, while the predominantly associated injury was rib fracture. The patients were managed preferably through nonoperative management, followed by angioembolization and operative management. The commonest postoperative complication was pneumonia. CONCLUSIONS Nonoperative management of splenic trauma has evolved as the standard of care replacing operative management in order to sustain its immune function, thereby preventing overwhelming post-splenectomy infection.
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Affiliation(s)
- Sunil Kumar
- Division of Trauma Surgery, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vivek Katiyar
- Division of Trauma Surgery, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Sumit Sharma
- Division of Trauma Surgery, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vipul K Srivastava
- Division of Trauma Surgery, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Satyanam K Bhartiya
- Division of Trauma Surgery, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Shashi P Mishra
- Division of Trauma Surgery, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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10
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Sammoud S, Ghelfi J, Barbois S, Beregi JP, Arvieux C, Frandon J. Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy-An Ancillary Study. J Pers Med 2023; 13:889. [PMID: 37373879 DOI: 10.3390/jpm13060889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive proximal splenic artery embolization (PPSAE). This ancillary study, using the SPLASH multicenter randomized prospective cohort, evaluated the feasibility, safety, and efficacy of PPSAE in patients with high-grade blunt splenic trauma without vascular anomaly on the initial CT scan. All patients included were over 18 years old, had high-grade splenic trauma (≥AAST-OIS 3 + hemoperitoneum) without vascular anomaly on the initial CT scan, received PPSAE, and had a CT scan at one month. Technical aspects, efficacy, and one-month splenic salvage were studied. Fifty-seven patients were reviewed. Technical efficacy was 94% with only four proximal embolization failures due to distal coil migration. Six patients (10.5%) underwent combined embolization (distal + proximal) due to active bleeding or focal arterial anomaly discovered during embolization. The mean procedure time was 56.5 min (SD = 38.1 min). Embolization was performed with an Amplatzer™ vascular plug in 28 patients (49.1%), a Penumbra occlusion device in 18 patients (31.6%), and microcoils in 11 patients (19.3%). There were two hematomas (3.5%) at the puncture site without clinical consequences. There were no rescue splenectomies. Two patients were re-embolized, one on Day 6 for an active leak and one on Day 30 for a secondary aneurysm. Primary clinical efficacy was, therefore, 96%. There were no splenic abscesses or pancreatic necroses. The splenic salvage rate on Day 30 was 94%, while only three patients (5.2%) had less than 50% vascularized splenic parenchyma. PPSAE is a rapid, efficient, and safe procedure that can prevent splenectomy in high-grade spleen trauma (AAST-OIS) ≥ 3 with high splenic salvage rates.
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Affiliation(s)
- Skander Sammoud
- Department of Radiology, Nîmes Carémeau University Hospital, 30900 Nimes, France
| | - Julien Ghelfi
- Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
- Department of Radiology, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Sandrine Barbois
- Department of Digestive Surgery, University Hospital Grenoble Alpes, 38043 Grenoble, France
| | - Jean-Paul Beregi
- Department of Radiology, Nîmes Carémeau University Hospital, 30900 Nimes, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France
| | - Julien Frandon
- Department of Radiology, Nîmes Carémeau University Hospital, 30900 Nimes, France
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11
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Chen H, Unberath M, Dreizin D. Toward automated interpretable AAST grading for blunt splenic injury. Emerg Radiol 2023; 30:41-50. [PMID: 36371579 DOI: 10.1007/s10140-022-02099-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The American Association for the Surgery of Trauma (AAST) splenic organ injury scale (OIS) is the most frequently used CT-based grading system for blunt splenic trauma. However, reported inter-rater agreement is modest, and an algorithm that objectively automates grading based on transparent and verifiable criteria could serve as a high-trust diagnostic aid. PURPOSE To pilot the development of an automated interpretable multi-stage deep learning-based system to predict AAST grade from admission trauma CT. METHODS Our pipeline includes 4 parts: (1) automated splenic localization, (2) Faster R-CNN-based detection of pseudoaneurysms (PSA) and active bleeds (AB), (3) nnU-Net segmentation and quantification of splenic parenchymal disruption (SPD), and (4) a directed graph that infers AAST grades from detection and segmentation results. Training and validation is performed on a dataset of adult patients (age ≥ 18) with voxelwise labeling, consensus AAST grading, and hemorrhage-related outcome data (n = 174). RESULTS AAST classification agreement (weighted κ) between automated and consensus AAST grades was substantial (0.79). High-grade (IV and V) injuries were predicted with accuracy, positive predictive value, and negative predictive value of 92%, 95%, and 89%. The area under the curve for predicting hemorrhage control intervention was comparable between expert consensus and automated AAST grading (0.83 vs 0.88). The mean combined inference time for the pipeline was 96.9 s. CONCLUSIONS The results of our method were rapid and verifiable, with high agreement between automated and expert consensus grades. Diagnosis of high-grade lesions and prediction of hemorrhage control intervention produced accurate results in adult patients.
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Affiliation(s)
- Haomin Chen
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Mathias Unberath
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - David Dreizin
- Emergency and Trauma Imaging, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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12
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Xu SS, Eng K, Accorsi F, Cool DW, Wiseman D, Mujoomdar A, Cardarelli-Leite L. Proximal splenic artery embolization using a vascular plug in grade IV or V splenic trauma - a single centre 11-year experience. CVIR Endovasc 2023; 6:1. [PMID: 36627472 PMCID: PMC9832195 DOI: 10.1186/s42155-022-00345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Samuel S. Xu
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada ,Halton Healthcare Services, 3001 Hospital Gate, Oakville, ON L6M 0L8 Canada
| | - Kevin Eng
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Fabio Accorsi
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Derek W. Cool
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Daniele Wiseman
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Amol Mujoomdar
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
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13
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Cairl N, Sharp V. Splenic abscess secondary to COVID-19 infection - A case report. Int J Surg Case Rep 2022; 101:107807. [PMID: 36455347 PMCID: PMC9705012 DOI: 10.1016/j.ijscr.2022.107807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nicholas Cairl
- Department of Surgery, Trinity Health Ann Arbor, 5301 McAuley Dr, Ypsilanti, MI 48197, United States of America,Corresponding author.
| | - Victoria Sharp
- Trinity Health IHA Medical Group, Trauma & Surgical Critical Care, Trinity Health Ann Arbor, 5301 McAuley Dr, Ypsilanti, MI 48197, United States of America
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14
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Jenkins P, Harborne K, Liu W, Zhong J, Harding J. Splenic embolisation practices within the UK: a national survey. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.09.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Xu Y, Wu Z. A case of a pregnant woman with a special splenic artery aneurysm. Malawi Med J 2022; 34:220-222. [PMID: 36406093 PMCID: PMC9641609 DOI: 10.4314/mmj.v34i3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Visceral artery aneurysm, especially splenic artery aneurysm, is rare and is usually associated with pregnancy. When such aneurysms rupture, they can be fatal, and they often require emergency surgery. This case report includes a review of the literature and describes a effective multidisciplinary approach to managing this type of aneurysm. We describe the treatment of a ruptured splenic artery aneurysm and the careful coordination of obstetric, vascular surgery, and intensive care teams. The uniqueness of this case arose from the metal embolization coil that was found to have fallen off from a recently embolized ruptured splenic artery aneurysm. The management of this ruptured splenic artery aneurysm and iatrogenic foreign body insult required a combination of multiple specialties to provide life-saving treatment. Such cases should be managed by multidisciplinary teams if institutional resources allow for it.
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Affiliation(s)
- Yujia Xu
- Department of vascular surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Zhoupeng Wu
- Department of vascular surgery, West China Hospital, Sichuan University, Sichuan Province, China
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16
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Dreizin D, Yu T, Motley K, Li G, Morrison JJ, Liang Y. Blunt splenic injury: Assessment of follow-up CT utility using quantitative volumetry. FRONTIERS IN RADIOLOGY 2022; 2. [PMID: 36120383 PMCID: PMC9479763 DOI: 10.3389/fradi.2022.941863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: Trials of non-operative management (NOM) have become the standard of care for blunt splenic injury (BSI) in hemodynamically stable patients. However, there is a lack of consensus regarding the utility of follow-up CT exams and relevant CT features. The purpose of this study is to determine imaging predictors of splenectomy on follow-up CT using quantitative volumetric measurements. Methods: Adult patients who underwent a trial of non-operative management (NOM) with follow-up CT performed for BSI between 2017 and 2019 were included (n = 51). Six patients (12% of cohort) underwent splenectomy; 45 underwent successful splenic salvage. Voxelwise measurements of splenic laceration, hemoperitoneum, and subcapsular hematoma were derived from portal venous phase images of admission and follow-up scans using 3D slicer. Presence/absence of pseudoaneurysm on admission and follow-up CT was assessed using arterial phase images. Multivariable logistic regression was used to determine independent predictors of decision to perform splenectomy. Results: Factors significantly associated with splenectomy in bivariate analysis incorporated in multivariate logistic regression included final hemoperitoneum volume (p = 0.003), final subcapsular hematoma volume (p = 0.001), change in subcapsular hematoma volume between scans (p = 0.09) and new/persistent pseudoaneurysm (p = 0.003). Independent predictors of splenectomy in the logistic regression were final hemoperitoneum volume (unit OR = 1.43 for each 100 mL change; 95% CI: 0.99–2.06) and new/persistent pseudoaneurysm (OR = 160.3; 95% CI: 0.91–28315.3). The AUC of the model incorporating both variables was significantly higher than AAST grading (0.91 vs. 0.59, p = 0.025). Mean combined effective dose for admission and follow up CT scans was 37.4 mSv. Conclusion: Follow-up CT provides clinically valuable information regarding the decision to perform splenectomy in BSI patients managed non-operatively. Hemoperitoneum volume and new or persistent pseudoaneurysm at follow-up are independent predictors of splenectomy.
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Affiliation(s)
- David Dreizin
- Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States
- CORRESPONDENCE: David Dreizin
| | - Theresa Yu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kaitlynn Motley
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Guang Li
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jonathan J. Morrison
- Vascular Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Yuanyuan Liang
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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17
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Han J, Dudi-Venkata NN, Jolly S, Ting YY, Lu H, Thomas M, Dobbins C. Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries - A level 1 Australian Trauma centre experience. Injury 2022; 53:1620-1626. [PMID: 34991862 DOI: 10.1016/j.injury.2021.12.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Splenic injuries are the most common visceral injury following blunt abdominal trauma. Increasingly, non-operative management (NOM) and the use of adjunctive splenic angioembolization (ASE) is favoured over operative management (OM) for the hemodynamically stable patient. However, clinical predictors for successful NOM, particularly the role of ASE as an adjunct, remain poorly defined. This study aims to evaluate the outcomes of patients undergoing ASE vs NOM. METHODS A retrospective clinical audit was performed of all patients admitted with blunt splenic injury (BSI) from January 2005 to January 2018 at the Royal Adelaide Hospital. The primary outcome was ASE or NOM failure rate. Secondary outcomes were grade of splenic injury, Injury Severity Score (ISS), length of hospital stay (LOS), and delayed OM or re-angioembolization rates. RESULTS Of 208 patients with BSI, 60 (29%) underwent OM, 54 (26%) ASE, and 94 (45%) NOM only. Patients were predominantly male 165 (79%), with a median age of 33 (IQR 24-51) years. The median ISS was 29 (20-38). There was no difference in the overall success rates for each modality of primary management (48 (89%) ASE vs 77 (82%) NOM, p = 0.374), though patients managed with ASE were older (38 vs 30 years, p = 0.029), had higher grade of splenic injury (grade ≥ IV 42 (78%) vs 8 (8.5%), p<0.001), with increased rates of haemo-peritoneum (46 (85%) vs 51 (54%), p<0.001) and contrast blush (42 (78%) vs 2 (2%), p<0.001). However, for grade III splenic injury, patients managed with ASE had a trend towards better outcome with no failures when compared to the NOM group (0 (0%) vs 8 (35%), p = 0.070) with a significant reduction in LOS (7.2 vs 10.8 days, p = 0.042). Furthermore, the ASE group overall had a significantly shorter LOS compared to the NOM group (10.0 vs 16.0 days, p<0.001). CONCLUSION ASE as an adjunct to NOM significantly reduces the length of stay in BSI patients and is most successful in managing AAST grade III injuries.
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Affiliation(s)
- Jennie Han
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia
| | | | - Samantha Jolly
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ying Yang Ting
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Ha Lu
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Meredith Thomas
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Christopher Dobbins
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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18
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Entriken C, Weed Z, Parikh PP, Ekeh AP. Complications Following Splenic Embolization for Trauma: Have Things Changed Over Time? J Surg Res 2022; 277:44-49. [PMID: 35460920 DOI: 10.1016/j.jss.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/20/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Splenic artery embolization (SAE) is a routinely used adjunct in the nonoperative management (NOM) of blunt splenic injury (BSI). The purpose of this study was to evaluate the rate and type of adverse events that occur in patients undergoing SAE and to compare this with the previous data. METHODS Patients who had SAE for BSI between 2011 and 2018 were identified. Splenic abscess, splenic infarction, and contrast-induced renal insufficiency were considered major complications. Coil migration, fever, and pleural effusions were regarded minor complications. The results were compared with data from a prior study examining similar indices at the same trauma center between 2000 and 2010. RESULTS There were 716 patients admitted with BSI. SAE was performed in 74 (13.3%) of the 557 (78%) NOM patients. The overall complication rate was 33.8%. Major complications occurred in 11 patients (14.9%) and minor in 13 patients (18.9%). There was no association between complications and coil location by logistic regression. CONCLUSIONS SAE continues to be a useful adjunct in the NOM of BSI though complications continue to occur. Fewer minor complications were noted in the period studied compared to past similar studies.
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Affiliation(s)
| | - Zachary Weed
- Department of Surgery, Wright State University, Dayton, Ohio
| | - Priti P Parikh
- Department of Surgery, Wright State University, Dayton, Ohio
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19
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Xie Y, Gao P, He F, Zhang C. Application of Alginate-Based Hydrogels in Hemostasis. Gels 2022; 8:109. [PMID: 35200490 PMCID: PMC8871293 DOI: 10.3390/gels8020109] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
Hemorrhage, as a common trauma injury and clinical postoperative complication, may cause serious damage to the body, especially for patients with huge blood loss and coagulation dysfunction. Timely and effective hemostasis and avoidance of bleeding are of great significance for reducing body damage and improving the survival rate and quality of life of patients. Alginate is considered to be an excellent hemostatic polymer-based biomaterial due to its excellent biocompatibility, biodegradability, non-toxicity, non-immunogenicity, easy gelation and easy availability. In recent years, alginate hydrogels have been more and more widely used in the medical field, and a series of hemostatic related products have been developed such as medical dressings, hemostatic needles, transcatheter interventional embolization preparations, microneedles, injectable hydrogels, and hemostatic powders. The development and application prospects are extremely broad. This manuscript reviews the structure, properties and history of alginate, as well as the research progress of alginate hydrogels in clinical applications related to hemostasis. This review also discusses the current limitations and possible future development prospects of alginate hydrogels in hemostatic applications.
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Affiliation(s)
| | | | | | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.X.); (P.G.); (F.H.)
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20
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Tran S, Wilks M, Dawson J. Endovascular Management of Splenic Trauma. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Chahine AH, Gilyard S, Hanna TN, Fan S, Risk B, Johnson JO, Duszak R, Newsome J, Xing M, Kokabi N. Management of Splenic Trauma in Contemporary Clinical Practice: A National Trauma Data Bank Study. Acad Radiol 2021; 28 Suppl 1:S138-S147. [PMID: 33288400 DOI: 10.1016/j.acra.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To evaluate the utilization and efficacy of various treatments for management of adult patients with splenic trauma, highlighting the evolving role of splenic artery embolization. MATERIALS AND METHODS The National Trauma Data Bank (NTDB) was queried for patients who sustained splenic trauma between 2007 and 2015, excluding those with death on arrival and selected nonsplenic high-grade injuries. Patients were categorized into (1) nonoperative management (NOM), (2) embolization, (3) splenectomy, (4) splenic repair, and (5) combined treatment groups. Evaluated outcomes included hospital length of stay (LOS), intensive care unit LOS, mortality, and NOM and embolization failures. RESULTS Overall, 117,743 patients with splenic predominant trauma were included in this study. Over the 9-year study period, 85,793 (72.9%) were treated with NOM, 21,999 (18.9%) with splenectomy, 3895 (3.3%) with embolization, and 2131 (1.8%) with splenic repair. From 2007 to 2015, mortality rates declined from 7.6% to 4.7%. The rate of NOM did not significantly change over time, while embolization increased 369% (1.3%-4.8%). Failure of NOM was 4.4% in 2007 and decreased to 3.4% in 2015. Across all injury grades, NOM had the shortest LOS (8.3 days), followed by splenic repair (12.3), embolization (12.6), and splenectomy (13.8) (p < 0.001). When adjusted for various clinical factors including severity of splenic injury, mortality rates were 7.1% for splenectomy, 3.2% for embolization, and 2.5% for NOM. CONCLUSION Most patients with splenic-dominant blunt trauma are managed with NOM. Over time, the use of embolization has increased while open surgery has declined, and mortality has improved for all treatment methods. Compared to splenectomy, embolization is associated with shorter hospital LOS but is still used relatively infrequently.
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22
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Arvieux C, Thony F. Management of splenic trauma in hemodynamically stable patients: Lessons to be drawn from the French SPLASH trial (Splenic Arterial Embolization to Avoid Splenectomy (SPLASH) Study Group). J Visc Surg 2021; 159:43-46. [PMID: 34716120 DOI: 10.1016/j.jviscsurg.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Arvieux
- CS 10-232, General and Digestive Surgery Department, Université Grenoble-Alpes, CHU de Grenoble-Alpes, 38043 Grenoble cedex, France.
| | - F Thony
- CS 10-232, University Center of Imaging and Interventional Radiology (CURIM), CHU de Grenoble-Alpes, 38043 Grenoble cedex, France
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23
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Sasaki K, Okada T, Yamaguchi M, Tajiri M, Ahmed M, Gentsu T, Ueshima E, Sofue K, Sugimoto K, Murakami T. Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries. Jpn J Radiol 2021; 40:308-317. [PMID: 34613557 DOI: 10.1007/s11604-021-01203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries. MATERIALS AND METHODS Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann-Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors. RESULTS TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025). CONCLUSION TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.
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Affiliation(s)
- Koji Sasaki
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Masashi Tajiri
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Mostafa Ahmed
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Gentsu
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
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Kofinas AG, Stavrati KE, Symeonidis NG, Pavlidis ET, Psarras KK, Shulga IN, Marneri AG, Nikolaidou CC, Pavlidis TE. Non-Operative Management of Delayed Splenic Rupture 4 Months Following Blunt Abdominal Trauma. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932577. [PMID: 34417433 PMCID: PMC8392706 DOI: 10.12659/ajcr.932577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Delayed splenic rupture is a rare complication of non-operative management of a primary splenic trauma which, without proper clinical vigilance, may result in life-threatening events. It usually occurs 4-8 days after injury and, in most cases, surgery is the treatment of choice. Since non-operative management of splenic trauma, which allows splenic salvage, has become increasingly popular, the same approach could also be applied in delayed splenic rupture. We herein present a case of delayed splenic rupture that occurred 4 months after the trauma and was successfully managed non-operatively. CASE REPORT A 32-year-old woman presented with diffuse abdominal pain, chest pain, and dyspnea 4 months after sustaining minor thoracoabdominal blunt trauma due to a car accident. That event was inadequately investigated and was not admitted for further monitoring. Computerized tomography revealed a rupture of a splenic hematoma in the context of the previous splenic trauma. She was closely monitored and remained hemodynamically stable. She was discharged and followed up, with no reported relapse of her clinical condition. CONCLUSIONS Delayed splenic rupture occurring 4 months after the primary splenic trauma is extremely rare. Due to its prolonged delay, delayed rupture of the spleen can easily be overlooked and not be included in the original differential diagnosis. Negligence of this event can result in dreaded complications with hemodynamic instability or even death. Furthermore, its higher mortality rate compared to primary splenic rupture highlights the importance of proper clinical vigilance. Non-operative management should be attempted in hemodynamically stable patients.
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Jones C, Sattler S, Gekle R. Traumatic splenic laceration with delayed rupture secondary to coughing in a patient with Von Willebrand disease. Am J Emerg Med 2021; 50:812.e5-812.e7. [PMID: 34373071 DOI: 10.1016/j.ajem.2021.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
We describe the case of a 54-year-old male with Von Willebrand Disease who presented to the Emergency Department (ED) with 2 weeks of worsening abdominal pain after falling on his left flank while boating. On his initial presentation, he was found to have a Grade II splenic injury that was managed non operatively by the trauma service. Four days later, he returned to the ED when he developed severe abdominal pain after coughing and was found to have active extravasation from the splenic parenchyma with hemoperitoneum on CT angiography and a grossly positive FAST exam. Intraoperatively, he was found to have a Grade V splenic injury and subsequently underwent splenectomy.
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Affiliation(s)
- Christopher Jones
- Emergency Medicine Residency Program, Good Samaritan Hospital Medical Center, West Islip, NY, United States of America.
| | - Steven Sattler
- Emergency Medicine Residency Program, Good Samaritan Hospital Medical Center, West Islip, NY, United States of America
| | - Robert Gekle
- Emergency Medicine Residency Program, Good Samaritan Hospital Medical Center, West Islip, NY, United States of America
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26
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Cretcher M, Panick CEP, Boscanin A, Farsad K. Splenic trauma: endovascular treatment approach. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1194. [PMID: 34430635 PMCID: PMC8350634 DOI: 10.21037/atm-20-4381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used. Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.
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Affiliation(s)
- Maxwell Cretcher
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Catherine E P Panick
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Alexander Boscanin
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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27
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Ha G, Jang SW, Shin IS, Bang HJ, An S, Bae KS, Jang JY, Kim YW, Kim K. Finding new indicators for operation and angiographic embolization in blunt renal injury patients: a single-center experience over 13 years. Ann Surg Treat Res 2021; 101:49-57. [PMID: 34235116 PMCID: PMC8255582 DOI: 10.4174/astr.2021.101.1.49] [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: 02/03/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Traumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma. Methods The study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed. Results Multivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm. Conclusion When a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota's fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.
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Affiliation(s)
- Gaesung Ha
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Woo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - In Sik Shin
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Hui-Jae Bang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sanghyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, Trauma Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Young Wan Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
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28
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Venn GA, Clements W, Moriarty H, Goh GS. Proximal splenic embolisation versus distal splenic embolisation for management of focal distal arterial injuries of the spleen. J Med Imaging Radiat Oncol 2021; 65:869-874. [PMID: 34142762 DOI: 10.1111/1754-9485.13263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/28/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To compare the outcomes of proximal (pSAE) versus distal (dSAE) splenic artery embolisation for management of focal distal arterial splenic injuries secondary to blunt splenic trauma. METHOD Ethical approval was granted by the hospital research and ethics committee, Project 389/19. All patients who underwent splenic artery embolisation secondary to blunt abdominal trauma from 1 January 2009 to 1 January 2019 were reviewed. Patients with a tandem embolisation (both proximal and distal embolisations) or those with no acute vascular injury on angiography were excluded. Patient demographics, injury type/ AAST grade (2018 classification), technique of embolisation and outcomes were collected. Complications and splenectomy rates up to 30 days were recorded. RESULTS 136 out of 232 patients had an embolisation performed for a distal vascular injury including active arterial bleeding, pseudoaneurysm or arteriovenous fistula. Mean age was 41 (range 16-84). Mean AAST grade was 4 (range 3-5). Mean Injury Severity Score was 22. pSAE was performed in 79.4% (n = 108) and dSAE in 20.6% (n = 28). Major complications occurred in 12 patients (pSAE n = 12, 11.1%; dSAE n = 0, P > 0.05); 6 pSAE required splenectomy (n = 6, 5.6%). There was no significant difference in outcomes between the two groups or when based on AAST grading. CONCLUSION No significant difference was observed between proximal and distal embolisation techniques for blunt trauma patients with a distal vascular injury in terms of technical and clinical success.
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Affiliation(s)
| | - Warren Clements
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Clayton, Victoria, Australia.,National Trauma Research Institute, Monash University, Clayton, Victoria, Australia
| | - Heather Moriarty
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Gerard S Goh
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Clayton, Victoria, Australia.,National Trauma Research Institute, Monash University, Clayton, Victoria, Australia
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29
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Dariushnia SR, Redstone EA, Heran MKS, Cramer HR, Ganguli S, Gomes AS, Hogan MJ, Himes EA, Patel S, Schiro BJ, Lewis CA. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Transcatheter Embolization. J Vasc Interv Radiol 2021; 32:476.e1-476.e33. [PMID: 33640083 DOI: 10.1016/j.jvir.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303.
| | - Ellen A Redstone
- Department of Interventional Radiology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA, 18015
| | - Manraj K S Heran
- Pediatric Interventional Radiology, Diagnostic & Therapeutic Neuroradiology, British Columbia's Children's Hospital, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada
| | - Harry R Cramer
- Section of Interventional Radiology, Coastal Vascular and Interventional, PLLC, 3155 Hyde Park Place, Pensacola, FL, 32503
| | - Suvranu Ganguli
- Department of Radiology, Division of Interventional Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH 4th Floor, Boston, MA, 02118
| | - Antoinette S Gomes
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plz Ste 2125, Los Angeles, CA, 90095-8358
| | - Mark J Hogan
- Department of Radiology, Section of Vascular and Interventional Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Elizabeth A Himes
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Sheena Patel
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Brian J Schiro
- Department of Vascular & Interventional Radiology, Miami Cardiac & Vascular Institute, 8900 N. Kendall Drive, Miami, FL, 33156, United States
| | - Curtis A Lewis
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303
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30
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A pilot randomized controlled trial of endovascular coils and vascular plugs for proximal splenic artery embolization in high-grade splenic trauma. Abdom Radiol (NY) 2021; 46:2823-2832. [PMID: 33386906 DOI: 10.1007/s00261-020-02904-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 09/28/2020] [Accepted: 12/06/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the feasibility of enrolling patients in a randomized controlled trial (RCT) comparing endovascular coils (EC) and vascular plugs (VP) for proximal splenic artery embolization (pSAE) in high-grade splenic trauma, and to collect data to inform the design of a larger clinical effectiveness trial. METHODS Single-center, prospective, RCT of patients with Grade III-V splenic injuries selected for nonoperative management. Patients were randomized to pSAE with EC or VP. The main outcome was feasibility. We also evaluated technical success, time to stasis, complications, mortality, and splenectomy rates, by estimating rates and 95% confidence intervals. RESULTS 46 of 50 eligible patients were enrolled (92%, 95% CI 90-100%). Overall, splenic salvage was 98% (45/46; 95% CI 94-100%). Primary technical success was observed in 22 EC patients (96%; 95% CI 87-100%) and 20 VP patients (87%; 95% CI 73-100%). Bayesian analysis suggests a > 80% probability that primary technical success is higher for EC. Two complications (one major and one minor) occurred in the EC group (9%; CI 0-20%) and one major complication occurred in the VP group (4%; CI 0-13%). CONCLUSIONS Randomized comparisons of endovascular devices used for pSAE after trauma are feasible. pSAE using either EC or VP results in excellent rates of splenic salvage in trauma patients with high-grade splenic injuries. These high rates of splenic salvage and low rates of complications make their use as a primary outcome in a future trial problematic. Consideration should be given to technical parameters as a primary outcome for future trials.
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31
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Meira Júnior JD, Menegozzo CAM, Rocha MC, Utiyama EM. Non-operative management of blunt splenic trauma: evolution, results and controversies. Rev Col Bras Cir 2021; 48:e20202777. [PMID: 33978122 PMCID: PMC10683451 DOI: 10.1590/0100-6991e-20202777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022] Open
Abstract
The spleen is one of the most frequently affected organs in blunt abdominal trauma. Since Upadhyaya, the treatment of splenic trauma has undergone important changes. Currently, the consensus is that every splenic trauma presenting with hemodynamic stability should be initially treated nonoperatively, provided that the hospital has adequate structure and the patient does not present other conditions that indicate abdominal exploration. However, several topics regarding the nonoperative management (NOM) of splenic trauma are still controversial. Splenic angioembolization is a very useful tool for NOM, but there is no consensus on its precise indications. There is no definition in the literature as to how NOM should be conducted, neither about the periodicity of hematimetric control, the transfusion threshold that defines NOM failure, when to start venous thromboembolism prophylaxis, the need for control imaging, the duration of bed rest, and when it is safe to discharge the patient. The aim of this review is to make a critical analysis of the most recent literature on this topic, exposing the state of the art in the NOM of splenic trauma.
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Affiliation(s)
- José Donizeti Meira Júnior
- - Hospital das Clínicas da Universidade de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | | | - Marcelo Cristiano Rocha
- - Hospital das Clínicas da Universidade de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Edivaldo Massazo Utiyama
- - Hospital das Clínicas da Universidade de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
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32
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Habash M, Ceballos D, Gunn AJ. Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes. Semin Intervent Radiol 2021; 38:105-112. [PMID: 33883807 DOI: 10.1055/s-0041-1724010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.
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Affiliation(s)
- Majd Habash
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Darrel Ceballos
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Birindelli A, Martin M, Khan M, Gallo G, Segalini E, Gori A, Yetasook A, Podda M, Giuliani A, Tugnoli G, Lim R, Di Saverio S. Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise. Updates Surg 2021; 73:1515-1531. [PMID: 33837949 PMCID: PMC8397689 DOI: 10.1007/s13304-021-01045-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023]
Abstract
Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.
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Affiliation(s)
- Arianna Birindelli
- Department of Surgery, University of Bologna, Bologna, Italy.,General, Trauma and Emergency Surgery Unit, Bufalini Hospital, Cesena, Italy.,General and Emergency Surgery Unit, Esine General Hospital, ASST Valcamonica, Breno, BS, Italy
| | - Matthew Martin
- Department of Trauma and Acute Care Surgery, Scripps Mercy Hospital, San Diego, CA, USA
| | - Mansoor Khan
- Digestive Diseases Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Edoardo Segalini
- Department of General and Emergency Surgery, ASST, Crema, CR, Italy
| | - Alice Gori
- Department of Surgery, University of Bologna, Bologna, Italy
| | - Amy Yetasook
- Harbor-UCLA Department of Surgery, Torrence, CA, USA
| | - Mauro Podda
- Emergency and Minimally Invasive Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Antonio Giuliani
- General and Emergency Surgery Unit, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
| | - Robert Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, HI, USA
| | | | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, UK. .,General Surgery Unit 1, Department of General Surgery, Ospedale Di Circolo, University of Insubria, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
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34
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Predictors for Failure of Non-operative Management of Splenic Injuries. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lee JT, Slade E, Uyeda J, Steenburg SD, Chong ST, Tsai R, Raptis D, Linnau KF, Chinapuvvula NR, Dattwyler MP, Dugan A, Baghdanian A, Flink C, Baghdanian A, LeBedis CA. American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings. Radiology 2021; 299:122-130. [PMID: 33529133 DOI: 10.1148/radiol.2021202917] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Treatment of blunt splenic trauma (BST) continues to evolve with improved imaging for detection of splenic vascular injuries. Purpose To report on treatments for BST from 11 trauma centers, the frequency and clinical impact of splenic vascular injuries, and factors influencing treatment. Materials and Methods Patients were retrospectively identified as having BST between January 2011 and December 2018, and clinical, imaging, and outcome data were recorded. Patient data were summarized descriptively, both overall and stratified by initial treatment received (nonoperative management [NOM], angiography, or surgery). Regression analyses were used to examine the primary outcomes of interest, which were initial treatment received and length of stay (LOS). Results This study evaluated 1373 patients (mean age, 42 years ± 18; 845 men). Initial treatments included NOM in 849 patients, interventional radiology (IR) in 240 patients, and surgery in 284 patients. Rates from CT reporting were 22% (304 of 1373) for active splenic hemorrhage (ASH) and 20% (276 of 1373) for contained vascular injury (CVI). IR management of high-grade injuries increased 15.6%, from 28.6% (eight of 28) to 44.2% (57 of 129) (2011-2012 vs 2017-2018). Patients who were treated invasively had a higher injury severity score (odds ratio [OR], 1.04; 95% CI: 1.02, 1.05; P < .001), lower temperature (OR, 0.97; 95% CI: 0.97, 1.00; P = .03), and a lower hematocrit (OR, 0.96; 95% CI: 0.93, 0.99; P = .003) and were more likely to show ASH (OR, 8.05; 95% CI: 5.35, 12.26; P < .001) or CVI (OR, 2.70; 95% CI: 1.64, 4.44; P < .001) on CT images, have spleen-only injures (OR, 2.35; 95% CI: 1.45, 3.8; P < .001), and have been administered blood product for fewer than 24 hours (OR, 2.35; 95% CI: 1.58, 3.51; P < .001) compared with those chosen for NOM, after adjusting for key demographic and clinical variables. After adjustment, factors associated with a shorter LOS were female sex (OR, 0.84; 95% CI: 0.73, 0.96; P = .009), spleen-only injury (OR, 0.72; 95% CI: 0.6, 0.86; P < .001), higher admission hematocrit (OR, 0.98; 95% CI: 0.6, 0.86; P < .001), and presence of ASH at CT (OR, 0.74; 95% CI: 0.62, 0.88; P < .001). Conclusion Contained vascular injury and active splenic hemorrhage (ASH) were frequently reported, and rates of interventional radiologic management increased during the study period. ASH was associated with a shorter length of stay, and patients with ASH had eight times the odds of undergoing invasive treatment compared with undergoing nonoperative management. © RSNA, 2021 See also the editorial by Patlas in this issue.
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Affiliation(s)
- James T Lee
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Emily Slade
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Jennifer Uyeda
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Scott D Steenburg
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Suzanne T Chong
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Richard Tsai
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Demetrios Raptis
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Ken F Linnau
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Naga R Chinapuvvula
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Matthew P Dattwyler
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Adam Dugan
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Arthur Baghdanian
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Carl Flink
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Armonde Baghdanian
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
| | - Christina A LeBedis
- From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)
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Bouzat P, Thony F, Arvieux C. Management of splenic injury after blunt abdominal trauma: insights from the SPLASH trial. Anaesth Crit Care Pain Med 2020; 39:747-748. [PMID: 33122040 DOI: 10.1016/j.accpm.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pierre Bouzat
- Grenoble Alps Trauma centre, Department of anaesthesiology and intensive care medicine, Grenoble-Alpes University Hospital, F-38000, Grenoble, France.
| | - Frédéric Thony
- Department of Imaging and Interventional Radiology, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Catherine Arvieux
- Department of General and Digestive Surgery, Grenoble-Alpes University Hospital, 38000 Grenoble, France
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Predictors of surgical management of high grade blunt splenic injuries in adult trauma patients: a 5-year retrospective cohort study from an academic level I trauma center. Patient Saf Surg 2020; 14:32. [PMID: 32774457 PMCID: PMC7398213 DOI: 10.1186/s13037-020-00257-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
Backgrounds Splenic injury accounts for 40% of all injuries after blunt abdominal trauma. Blunt splenic injury in hemodynamically unstable patients is preferably treated by splenectomy. Nowadays hemodynamically stable patients with low grade splenic injuries are mostly treated by non-operative management (NOM). However no consensus exists about the management of high grade splenic injuries in hemodynamically stable patients. Therefore the aim of this study was to analyze patients with high grade splenic injuries in our institution. Methods We retrospectively included all patients with a splenic injury presented to our level I trauma center during the 5-year period from January 1, 2012, until December 31, 2017. Baseline characteristics, data regarding complications and mortality were collected from the electronic patient registry. Patients were grouped based on splenic injury and the treatment they received. Results A total of 123 patients were included, of which 93 (75.6%) were male with a median age of 31 (24–52) and a median injury severity score of 27 (17–34). High grade injuries (n = 28) consisted of 20 Grade IV injuries and 8 grade V injuries. Splenectomy was required in 15/28 (53.6%) patients, of whom all remained hemodynamically unstable after resuscitation, including all grade V injuries. A total of 13 patients with high grade injuries were treated with spleen preserving therapy. Seven of these patients received angio-embolization. One patient went for laparotomy and the spleen was treated with a hemostatic agent. Secondary hemorrhage was present in 3 of these patients (initial treatment: 1 embolization/ 2 observational), resulting in a success rate of 76.9%. There is no mortality seen in patient with high grade splenic injuries. Conclusion Non-operative treatment in high grade splenic injuries is a safe treatment modality in hemodynamically stable patients. Hemodynamic status and peroperative bleeding, not injury severity or splenic injury grade were the drivers for surgical management by splenectomy. This selected cohort of patients must be closely monitored to prevent adverse outcomes from secondary delayed bleeding in case of non-operative management.
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Guinto R, Greenberg P, Ahmed N. Emergency Management of Blunt Splenic Injury in Hypotensive Patients : Total Splenectomy Versus Splenic Angioembolization. Am Surg 2020; 86:690-694. [PMID: 32683975 DOI: 10.1177/0003134820923325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study is to examine the outcomes of splenic angioembolization (SAE) as the first modality for nonoperative management (NOM) in hypotensive patients with high-grade splenic injuries. METHODS Data were collected from the 2007-2010 National Trauma Data Bank data sets of the United States. The data included patients with massive blunt splenic injuries with an Abbreviated Injury Scale (AIS) of 4 or 5, initial systolic blood pressure ≤90, and who underwent either a total splenectomy or SAE (Group 1 and Group 2, respectively) within 4 hours of hospital arrival. The outcomes of interest are in-hospital mortality and complications. RESULTS Of the 1052 patients analyzed, 996 (94.7%) underwent total splenectomy while 56 (5.3%) underwent SAE. There were significant differences regarding injury mechanism (P = .01) and the proportion of patients with an AIS of 5 (57.6% vs 39.3% respectively, P = .01). A significantly higher number of patients, however, developed organ space infections (3.9% vs 11.6%, P = .02) in Group 2. The multivariate logistic regression model for mortality, which accounted for demography, Glasgow Coma Scale Motor (GCSM) score, Injury Severity Score (ISS), AIS, time to procedure, and procedure type showed the procedure type was not a contributing factor to patient mortality, but higher age, ISS, and lower GCSM score were strong predictors of mortality. CONCLUSION The treatment of approximately 95% of hypotensive patients with massive splenic injury was total splenectomy. However, if the interventional radiology resources are immediately available, SAE can be used as a first intervention without an increased risk of mortality.
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Affiliation(s)
- Robyn Guinto
- 23498 Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Patricia Greenberg
- 23498 Department of Research Administration, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Nasim Ahmed
- 23498 Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA.,Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
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Liechti R, Fourie L, Stickel M, Schrading S, Link BC, Fischer H, Lehnick D, Babst R, Metzger J, Beeres FJP. Routine follow-up imaging has limited advantage in the non-operative management of blunt splenic injury in adult patients. Injury 2020; 51:863-870. [PMID: 32111461 DOI: 10.1016/j.injury.2020.02.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To date, limited evidence exists regarding follow-up imaging during the non-operative management (NOM) of blunt splenic injury (BSI), especially concerning ultrasound as first-line imaging modality. The aim of this study was to investigate the incidence and time to failure of NOM as well as to evaluate the relevance of follow-up imaging. METHODS All adult patients with BSI admitted to our level I trauma center, including two associated hospitals, between 01/01/2010 and 31/12/2017 were retrospectively analyzed. Demographic data, comorbidities, injury pattern, trauma mechanism, Injury Severity Score, splenic injury grade and free intra-abdominal fluid were reviewed. Additional analysis of indication, frequency, modality, results and consequences of follow-up imaging was performed. Risk factors for failure of NOM were evaluated using fisher's exact test. RESULTS A total of 122 patients with a mean age of 43.8 ± 20.7 years (16-84 years) met inclusion criteria. Twenty patients (16.4%) underwent immediate intervention. One-hundred-and-two patients (83.6%) were treated by NOM. Failure of NOM occurred in 4 patients (3.9%). Failure was significantly associated with active bleeding (3 of 4 [75%] failures vs. 8 of 98 [8.2%] non-failures, OR 33.75, 95% CI 3.1, 363.2, p = 0.004), and liver cirrhosis (2 of 4 [50%] failures vs. 0 of 98 [0%] non-failures, OR 197, 95% CI 7.4, 5265.1, p = 0.001). Eighty patients (78.4%) in the NOM-Group received follow-up imaging by ultrasound (US, n = 51) or computed tomography (CT, n = 29). In 57 cases, routine imaging examinations were conducted (43 US and 14 CT scans) without prior clinical deterioration. Fifty-fife (96.4%) of these imaging results revealed no new significant findings. Every failure of NOM was detected following clinical deterioration in the first 48 h. CONCLUSION To our knowledge this study includes the largest single centric patient cohort undergoing ultrasound as first-line follow-up imaging modality in the NOM setting of BSI in adult patients. The results indicate that a routine follow-up imaging, regardless of the modality, has limited therapeutic advantage. Indication for radiological follow-up should be based on clinical findings. If indicated, a CT scan should be used as preferred imaging modality.
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Affiliation(s)
- Rémy Liechti
- Department of General and Visceral Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, CH-6000 Lucerne 16, Switzerland.
| | - Lana Fourie
- Department of General and Visceral Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, CH-6000 Lucerne 16, Switzerland
| | - Michael Stickel
- Interdisciplinary Emergency Department, Cantonal Hospital of Lucerne, Switzerland
| | - Simone Schrading
- Department of Radiology, Cantonal Hospital of Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Switzerland
| | - Henning Fischer
- Interdisciplinary Emergency Department, Cantonal Hospital of Lucerne, Switzerland
| | - Dirk Lehnick
- Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Switzerland
| | - Jürg Metzger
- Department of General and Visceral Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, CH-6000 Lucerne 16, Switzerland
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Switzerland
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Abstract
OBJECTIVE To develop French guidelines on the management of patients with severe abdominal trauma. DESIGN A consensus committee of 20 experts from the French Society of Anaesthesiology and Critical Care Medicine (Société française d'anesthésie et de réanimation, SFAR), the French Society of Emergency Medicine (Société française de médecine d'urgence, SFMU), the French Society of Urology (Société française d'urologie, SFU) and from the French Association of Surgery (Association française de chirurgie, AFC), the Val-de-Grâce School (École du Val-De-Grâce, EVG) and the Federation for Interventional Radiology (Fédération de radiologie interventionnelle, FRI-SFR) was convened. Declaration of all conflicts of interest (COI) policy by all participants was mandatory throughout the development of the guidelines. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for assessment of the available level of evidence with particular emphasis to avoid formulating strong recommendations in the absence of high level. Some recommendations were left ungraded. METHODS The guidelines are divided in diagnostic and, therapeutic strategy and early surveillance. All questions were formulated according to Population, Intervention, Comparison, and Outcomes (PICO) format. The panel focused on three questions for diagnostic strategy: (1) What is the diagnostic performance of clinical signs to suggest abdominal injury in trauma patients? (2) Suspecting abdominal trauma, what is the diagnostic performance of prehospital FAST (Focused Abdominal Sonography for Trauma) to rule in abdominal injury and guide the prehospital triage of the patient? and (3) When suspecting abdominal trauma, does carrying out a contrast enhanced thoraco-abdominal CT scan allow identification of abdominal injuries and reduction of mortality? Four questions dealt with therapeutic strategy: (1) After severe abdominal trauma, does immediate laparotomy reduce morbidity and mortality? (2) Does a "damage control surgery" strategy decrease morbidity and mortality in patients with a severe abdominal trauma? (3) Does a laparoscopic approach in patients with abdominal trauma decrease mortality or morbidity? and (4) Does non-operative management of patients with abdominal trauma without bleeding reduce mortality and morbidity? Finally, one question was formulated regarding the early monitoring of these patients: In case of severe abdominal trauma, which kind of initial monitoring does allow to reduce the morbi-mortality? The analysis of the literature and the recommendations were conducted following the GRADE® methodology. RESULTS The SFAR/SFMU Guideline panel provided 15 statements on early management of severe abdominal trauma. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), six have a low level of evidence (Grade 2±) and four are expert judgments. Finally, no recommendation was provided for one question. CONCLUSIONS Substantial agreement exists among experts regarding many strong recommendations for the best early management of severe abdominal trauma.
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Commentary on "Is strict adherence to the nonoperative management protocol associated with better outcome in patients with blunt splenic injuries?: A retrospective comparative cross-sectional study." Int J Surg 2019;69:116-123. Int J Surg 2019; 71:166. [PMID: 31589933 DOI: 10.1016/j.ijsu.2019.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 11/23/2022]
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Pape HC, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020. Injury 2019; 50:1656-1670. [PMID: 31558277 DOI: 10.1016/j.injury.2019.09.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. METHODS I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. INCLUSION CRITERIA adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). RESULTS I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. CONCLUSIONS Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.
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Affiliation(s)
- H-C Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - S Halvachizadeh
- Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - L Leenen
- Department of Trauma, University Medical Centre Utrecht, Suite G04.228, Heidelberglaan 100, 3585 GA, Utrecht, the Netherlands.
| | - G D Velmahos
- Dept. of Trauma, Emergency Surgery and Critical Care, Harvard University, Mass. General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - R Buckley
- Section of Orthopedic Trauma, University of Calgary, Foothills Medical Center, 0490 McCaig Tower, 3134 University Drive NW Calgary, Alberta, T2N 5A1, Canada.
| | - P V Giannoudis
- Trauma & Orthopaedic Surgery, Clarendon Wing, A Floor, Great George Street, Leeds General Infirmary University Hospital, University of Leeds, Leeds, LS1 3EX, UK.
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Coccolini F, Fugazzola P, Morganti L, Ceresoli M, Magnone S, Montori G, Tomasoni M, Maccatrozzo S, Allievi N, Occhionorelli S, Kluger Y, Sartelli M, Baiocchi GL, Ansaloni L, Catena F. The World Society of Emergency Surgery (WSES) spleen trauma classification: a useful tool in the management of splenic trauma. World J Emerg Surg 2019; 14:30. [PMID: 31236130 PMCID: PMC6580626 DOI: 10.1186/s13017-019-0246-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background The World Society of Emergency Surgery (WSES) spleen trauma classification meets the need of an evolution of the current anatomical spleen injury scale considering both the anatomical lesions and their physiologic effect. The aim of the present study is to evaluate the efficacy and trustfulness of the WSES classification as a tool in the decision-making process during spleen trauma management. Methods Multicenter prospective observational study on adult patients with blunt splenic trauma managed between 2014 and 2016 in two Italian trauma centers (ASST Papa Giovanni XXIII in Bergamo and Sant’Anna University Hospital in Ferrara). Risk factors for operative management at the arrival of the patient and as a definitive treatment were analyzed. Moreover, the association between the different WSES grades of injury and the definitive management was analyzed. Results One hundred twenty-four patients were included. At multivariate analysis, a WSES splenic injury grade IV is a risk factor for the operative management both at the arrival of the patients and as a definitive treatment. WSES splenic injury grade III is a risk factor for angioembolization. Conclusions The WSES classification is a good and reliable tool in the decision-making process in splenic trauma management.
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Affiliation(s)
- Federico Coccolini
- 1General, Emergency and Trauma Surgery Department, Bufalini Hospital, Viale Ghirotti 268, 47521 Cesena, Italy.,2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Fugazzola
- 1General, Emergency and Trauma Surgery Department, Bufalini Hospital, Viale Ghirotti 268, 47521 Cesena, Italy.,2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lucia Morganti
- 3General and Emergency Surgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Marco Ceresoli
- 1General, Emergency and Trauma Surgery Department, Bufalini Hospital, Viale Ghirotti 268, 47521 Cesena, Italy.,Emergency and Trauma Surgery, Rambam Medical Centra, Haifa, Israel
| | - Stefano Magnone
- 2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Montori
- 2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Matteo Tomasoni
- 1General, Emergency and Trauma Surgery Department, Bufalini Hospital, Viale Ghirotti 268, 47521 Cesena, Italy.,2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Maccatrozzo
- 2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Niccolò Allievi
- 2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Savino Occhionorelli
- 3General and Emergency Surgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Yoram Kluger
- Emergency and Trauma Surgery, Rambam Medical Centra, Haifa, Israel
| | | | - Gian Luca Baiocchi
- 6Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Ansaloni
- 1General, Emergency and Trauma Surgery Department, Bufalini Hospital, Viale Ghirotti 268, 47521 Cesena, Italy.,2General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Catena
- 7Emergency Surgery Department, Parma University Hospital, Parma, Italy
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Moon J, Jung K, Choi D, Kang BH, Huh Y, Lee JCJ, Kwon J. Analysis of the need for surgery for different anatomical locations of splenic injury and radiologic intervention. Clin Anat 2019; 33:516-521. [PMID: 31066935 DOI: 10.1002/ca.23401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 11/06/2022]
Abstract
The splenic surface can be anatomically divided into the visceral surface connected to major blood vessels and the diaphragmatic surface attached to the diaphragm. This study aimed to investigate differences in future treatment and outcomes according to the anatomical location of splenic injuries following abdominal trauma. Patients who were treated at a single trauma center between January 2011 and April 2018 were included. The presence of lacerations or hematoma on the visceral surface was evaluated via computed tomography. Differences in the location of splenic surgery between a group that underwent surgical or radiologic intervention and a group that received conservative care only were analyzed. Of 355 patients with splenic injury analyzed, the total mortality rate was 15.2%. A total of 167 patients underwent surgery and angiographic embolization, and 168 received conservative care only. Splenic injuries involved the visceral surface in 127 and 105 patients in the respective groups. Significant differences in the incidence of splenic injuries involving the visceral surface were found between the two groups in the univariate and logistic regression analyses. The likelihood of needing surgery and treatments such as embolization was higher for cases of splenic injury involving the visceral surface than for splenic injuries that did not involve the visceral surface. Through additional research, it may become possible to analyze the location of a splenic injury to determine an effective and safe method of treatment and accurately predict a prognosis. Clin. Anat. 33:516-521, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Jonghwan Moon
- Department of Trauma Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Kyoungwon Jung
- Department of Trauma Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Donghwan Choi
- Department of Trauma Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Byung H Kang
- Department of Trauma Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Yo Huh
- Department of Trauma Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - John C-J Lee
- Department of Trauma Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Junsik Kwon
- Department of Trauma Surgery, Ajou University School of Medicine, Suwon, South Korea
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45
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Raaijmakers CP, Lohle PN, Lodder P, de Vries J. Quality of Life and Clinical Outcome After Traumatic Spleen Injury (SPLENIQ Study): Protocol for an Observational Retrospective and Prospective Cohort Study. JMIR Res Protoc 2019; 8:e12391. [PMID: 31066709 PMCID: PMC6533045 DOI: 10.2196/12391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background Little is known about the effect of a splenic rupture on the quality of life (QOL) of patients, although the spleen is one of the most frequently injured organs in blunt abdominal trauma. It is essential to obtain more knowledge about QOL after traumatic spleen injury so that this can be taken into account when choosing treatment. Objective The primary objective of the SPLENic Injury and Quality of life (SPLENIQ) study is to determine QOL after treatment for traumatic spleen injury. The secondary objective is to investigate clinical and imaging outcome in relation to QOL. Methods A combination of a retrospective single-center and a prospective multicenter observational cohort study will be conducted. Patients in the retrospective study have had a splenic injury after blunt abdominal trauma and were admitted for treatment to the ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis) in Tilburg between January 2005 and February 2017. Concerning the prospective cohort study, patients with splenic injury admitted to 1 of the 10 participating hospitals between March 2017 and December 2018 will be asked to participate. The follow-up period will be 1 year regarding QOL, clinical symptoms, and imaging. Patients in the retrospective study will complete 2 questionnaires: World Health Organization QOL assessment instrument-Bref (WHOQOL-Bref) and 12-Item Short-Form Health Survey (SF-12). Patients in the prospective study will complete 5 questionnaires at 1 week, 1 month, 3 months, 6 months, and 12 months after treatment: WHOQOL-Bref, SF-12, Euroqol 5-Dimensional 5-Level (EQ-5D-5L) questionnaire, Institute for Medical Technology Assessment (iMTA) Productivity Cost Questionnaire (iPCQ), and iMTA Medical Consumption Questionnaire (iMCQ). In both the retrospective and prospective study, patients treated with splenic artery embolization will undergo magnetic resonance imaging (MRI). The retrospective group will undergo MRI once, and the prospective group will undergo MRI 1 month and 1 year after treatment. Treatment of splenic injury depends on the severity of the splenic injury, the hemodynamic condition of the patient, and the hospital’s or doctor’s preference. This study is observational in nature without randomization. Concerning the retrospective data, multivariate analysis of covariance will be done. With regard to the prospective data, mixed linear modeling will be performed. Results This project was funded in April 2015 by ZonMw. The results of the retrospective study will be expected in March 2019. With regard to the prospective study, inclusion of patients was completed in December 2018 and data collection will be completed in December 2019. The first results will be expected in 2019. Conclusions To our knowledge, this is the first study that examines QOL in patients with a traumatic spleen injury. The SPLENIQ study responds to the shortage of information about QOL after treatment for traumatic spleen injury and may result in the development of a patient-oriented protocol. Trial Registration ClinicalTrials.gov NCT03099798; https://clinicaltrials.gov/ct2/show/NCT03099798 (Archived by WebCite at http://www.webcitation.org/714ZKV6A0). International Registered Report Identifier (IRRID) DERR1-10.2196/12391
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Affiliation(s)
- Claudia Pam Raaijmakers
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Trauma TopCare, Tilburg, Netherlands.,ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department of Radiology, Tilburg, Netherlands
| | - Paul Nm Lohle
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department of Radiology, Tilburg, Netherlands
| | - Paul Lodder
- Tilburg University, Department of Medical and Clinical Psychology, Tilburg, Netherlands.,Tilburg University, Department of Methodology and Statistics, Tilburg, Netherlands
| | - Jolanda de Vries
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Trauma TopCare, Tilburg, Netherlands.,Tilburg University, Department of Medical and Clinical Psychology, Tilburg, Netherlands.,ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department of Medical Psychology, Tilburg, Netherlands
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46
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Embolisation d’hémostase du thorax, de l’abdomen et du pelvis. Presse Med 2019; 48:398-410. [DOI: 10.1016/j.lpm.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/22/2019] [Indexed: 11/21/2022] Open
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47
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Quencer KB, Smith TA. Review of proximal splenic artery embolization in blunt abdominal trauma. CVIR Endovasc 2019; 2:11. [PMID: 32026033 PMCID: PMC7224246 DOI: 10.1186/s42155-019-0055-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/07/2019] [Indexed: 11/11/2022] Open
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Unstable patients undergo laparotomy and splenectomy. Stable patients with lower grade injuries are treated conservatively; those stable patients with moderate to severe splenic injuries (grade III-V) benefit from endovascular splenic artery embolization. Two widely used embolization approaches are proximal and distal splenic artery embolization. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. Distal embolization can be used in cases of focal injury. In this article we review relevant literature on splenic embolization indication, and technique, comparing and contrasting proximal and distal embolization. Additionally, we review relevant anatomy and discuss collateral perfusion pathways following proximal embolization. Finally, we review potential complications of splenic artery embolization.
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Affiliation(s)
- Keith Bertram Quencer
- Division of Interventional Radiology, University of Utah Department of Radiology, 30 N. 1900 E., Salt Lake City, UT, 84132, USA
| | - Tyler Andrew Smith
- Division of Interventional Radiology, University of Utah Department of Radiology, 30 N. 1900 E., Salt Lake City, UT, 84132, USA.
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48
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Lauerman M, Brenner M, Simpson N, Shanmuganathan K, Stein D, Scalea T. Extra-parenchymal splenic abnormalities not vascular injury predict need for primary splenectomy. Eur J Trauma Emerg Surg 2019; 46:1063-1069. [PMID: 30721339 DOI: 10.1007/s00068-019-01085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/30/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Radiographic indications for primary splenectomy (PS) in blunt splenic injury (BSI) after radiographic diagnosis are unknown. Improved understanding of radiographic characteristics of patients requiring splenectomy will help to appropriately triage patients to PS or non-operative management (NOM). METHODS A retrospective, single-center review was performed of BSI diagnosed with computerized tomography (CT). Patients undergoing splenectomy prior to CT diagnosis were excluded. RESULTS BSI was identified in 195 patients. On logistic regression, only subcapsular hematoma presence (OR 7.521, p = 0.002) and left upper quadrant hemoperitoneum (OR 6.146, p = 0.03) were associated with need for PS, while splenic laceration length, number of pseudoaneurysms (PSA), and active contrast extravasation (NS for all) were not. CONCLUSIONS Need for PS is predicted by extra-parenchymal pathology in subcapsular hematoma and hemoperitoneum. Splenic vascular injuries through PSA and active contrast extravasation do not predict the need for PS and can be considered for NOM.
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Affiliation(s)
- Margaret Lauerman
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA.
| | - Megan Brenner
- Department of Surgery, University of California Riverside School of Medicine, Moreno Valley, CA, 92555, USA
| | - Nana Simpson
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA
| | - Kathirkamanthan Shanmuganathan
- Division of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Deborah Stein
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA
| | - Thomas Scalea
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA
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Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries - a nationwide cohort study. Scand J Trauma Resusc Emerg Med 2019; 27:4. [PMID: 30635015 PMCID: PMC6329069 DOI: 10.1186/s13049-018-0578-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/11/2018] [Indexed: 12/27/2022] Open
Abstract
Background The long-term treatment trends of splenic injuries can provide guidance when treating trauma patients. The nonoperative management (NOM) of splenic injuries was introduced in early 1989. After decades of development, it has proven to be safe and is now the primary treatment choice worldwide. However, there remains a lack of nationwide registry data to support the feasibility and efficiency of NOM. Methods We used the Taiwan National Health Insurance Research Database to conduct a whole population-based cohort study. Patients admitted with blunt splenic injuries from 2002 to 2013 were identified. Demographic data, management methods, associated injuries, comorbidities and outcome parameters were collected. Patients were divided into 2 groups by the type of admitting institution: a tertiary center or a non-center hospital. We also used 4 years as an interval to analyze the changes in epidemiological data and treatment trends. Comparisons of the results of NOM and surgical management were also performed. Results A total of 12,455 patients were admitted with blunt splenic injuries between 2002 and 2013. Among the 11,551 patients treated in a single hospital after admission, patients underwent NOM more frequently at tertiary centers than at non-center hospitals (64.6% vs 50.3%). During the 12-year study period, the NOM rate increased from 56 to 73% in tertiary centers, while in noncenter hospitals, the rate only increased from 43 to 58%. The mortality rate decreased in tertiary centers from 8.9 to 7.2%, with no apparent change in noncenter hospitals. Complications occurred more frequently in the surgical management group. Conclusion There is a trend toward the use of NOM for blunt splenic injury treatments, and the outcomes from the NOM groups were not inferior to those of the operation group. In addition, tertiary centers performed more NOM than did non-center hospitals and better met the international consensus. Electronic supplementary material The online version of this article (10.1186/s13049-018-0578-y) contains supplementary material, which is available to authorized users.
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50
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Teuben MPJ, Spijkerman R, Blokhuis TJ, Pfeifer R, Teuber H, Pape HC, Leenen LPH. Safety of selective nonoperative management for blunt splenic trauma: the impact of concomitant injuries. Patient Saf Surg 2018; 12:32. [PMID: 30505349 PMCID: PMC6260576 DOI: 10.1186/s13037-018-0179-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Nonoperative management for blunt splenic injury is the preferred treatment. To improve the outcome of selective nonoperative therapy, the current challenge is to identify factors that predict failure. Little is known about the impact of concomitant injury on outcome. Our study has two goals. First, to determine whether concomitant injury affects the safety of selective nonoperative treatment. Secondly we aimed to identify factors that can predict failure. Methods From our prospective trauma registry we selected all nonoperatively treated adult patients with blunt splenic trauma admitted between 01.01.2000 and 12.21.2013. All concurrent injuries with an AIS ≥ 2 were scored. We grouped and compared patients sustaining solitary splenic injuries and patients with concomitant injuries. To identify specific factors that predict failure we used a multivariable regression analysis. Results A total of 79 patients were included. Failure of nonoperative therapy (n = 11) and complications only occurred in patients sustaining concomitant injury. Furthermore, ICU-stay as well as hospitalization time were significantly prolonged in the presence of associated injury (4 versus 13 days,p < 0.05). Mortality was not seen. Multivariable analysis revealed the presence of a femur fracture and higher age as predictors of failure. Conclusions Nonoperative management for hemodynamically normal patients with blunt splenic injury is feasible and safe, even in the presence of concurrent (non-hollow organ) injuries or a contrast blush on CT. However, associated injuries are related to prolonged intensive care unit- and hospital stay, complications, and failure of nonoperative management. Specifically, higher age and the presence of a femur fracture are predictors of failure.
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Affiliation(s)
- Michel Paul Johan Teuben
- 1Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Roy Spijkerman
- 1Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Taco Johan Blokhuis
- 2Department of Surgery, Maastricht University Medical Center, P. Debyelaan 24, 6229 HX Maastricht, The Netherlands
| | - Roman Pfeifer
- 3Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Henrik Teuber
- 3Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
| | - Hans-Christoph Pape
- 3Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
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