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Spoor K, Cull JD, Otaibi BW, Hazelton JP, Chipko J, Reynolds J, Fugate S, Pederson C, Zier LB, Jacobson LE, Williams JM, Easterday TS, Byerly S, Mentzer C, Hawke E, Cullinane DC, Ontengco JB, Bugaev N, LeClair M, Udekwu P, Josephs C, Noorbaksh M, Babowice J, Velopulos CG, Urban S, Goldenberg A, Ghobrial G, Pickering JM, Quarfordt SD, Aunchman AF, LaRiccia AK, Spalding C, Catalano RD, Basham JE, Edmundson PM, Nahmias J, Tay E, Norwood SH, Meadows K, Wong Y, Hardman C. Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study. Trauma Surg Acute Care Open 2024; 9:e001159. [PMID: 38464553 PMCID: PMC10921525 DOI: 10.1136/tsaco-2023-001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/25/2023] [Indexed: 03/12/2024] Open
Abstract
Objectives There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients. Methods A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined the failure rate of NOM for grade I versus grade II splenic injuries. We then performed bivariate comparisons of patients who failed NOM with those who did not. Results A total of 145 patients were included. Median Injury Severity Score was 17. The combined rate of failure for grade I-II injuries was 20.0%. There was no statistical difference in failure of NOM between grade I and II injuries with CB (18.2% vs 21.1%, p>0.05). Patients who failed NOM had an increased median hospital length of stay (p=0.024) and increased need for blood transfusion (p=0.004) and massive transfusion (p=0.030). Five patients (3.4%) died and 96 (66.2%) were discharged home, with no differences between those who failed and those who did not fail NOM (both p>0.05). Conclusion NOM of grade I-II splenic injuries with CB fails in 20% of patients. Level of evidence IV.
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Affiliation(s)
- Kristen Spoor
- Prisma Health Upstate, Greenville, South Carolina, USA
| | - John David Cull
- Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Banan W Otaibi
- Pennsylvania State University, Hershey, Pennsylvania, USA
| | | | - John Chipko
- Research Medical Center, Kansas City, Missouri, USA
| | | | - Sam Fugate
- University of Kentucky HealthCare, Lexington, Kentucky, USA
| | | | - Linda B Zier
- Medical Center of the Rockies, Loveland, Colorado, USA
| | - Lewis E Jacobson
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
| | - Jamie M Williams
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
| | | | | | - Caleb Mentzer
- Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Edward Hawke
- Spartanburg Regional Health System, Spartanburg, South Carolina, USA
| | | | | | | | | | - Pascal Udekwu
- Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | | | | | | | | | - Shane Urban
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Anna Goldenberg
- Trauma, Acute Care Surgery, and Surgical Critical Care, Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA
| | | | | | | | - Alia F Aunchman
- University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Chance Spalding
- Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA
| | - Richard D Catalano
- Loma Linda University Adventist Health Sciences Center, Loma Linda, California, USA
| | | | | | | | - Erika Tay
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | | | | | - Yee Wong
- Premier Health Partners Inc, Dayton, Ohio, USA
| | - Claire Hardman
- Wright State Physicians, Department of Surgery, Dayton, Ohio, USA
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Garner SM, Reparaz L, Justice J, Foster AP, Litzenberger S, Bell N, Schaller SL, Spoor K, Cull J, Watson CM, Dunkelberger LC. Percutaneous Endoscopic Gastrostomy Placement in Trauma Patients: Early vs Delayed Initiation of Enteral Feeding. Am Surg 2023:31348231157880. [PMID: 36797814 DOI: 10.1177/00031348231157880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
In critically ill trauma patients, adequate nutrition is essential for the body's healing process. Currently, there is no clinical standard for initiating feeds after percutaneous endoscopic gastrostomy (PEG) tube placement. We aimed to demonstrate that early enteral nutrition (EN) is as safe as delayed EN in patients who have undergone PEG tube insertion. We conducted a multi-center, retrospective cohort study of 384 patients from the Prisma Health Trauma Registries who received PEGs. Feeding intolerance was defined as high gastric residuals, nausea, emesis, sustained diarrhea, or ileus. The probability that a patient would experience intolerance was 11.7% in those fed within 6 hours, 5.1% among patients fed between 6 and 12 hours, 6.0% among patients fed between 12 and 24 hours, and 7.6% among patients fed after 24 hours, for which no statistically significant difference was detected. These findings support that early EN after PEG placement is safe in critically ill, trauma patients.
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Affiliation(s)
- Sydney M Garner
- 12322University of South Carolina School of Medicine, Columbia, SC, USA
| | - Laura Reparaz
- Trauma Research Development, 2630Prisma Health Midlands, Columbia, SC, USA
| | | | | | | | - Nathaniel Bell
- College of Nursing, 2629University of South Carolina, Columbia, SC, USA
| | | | | | - John Cull
- 3626Prisma Health, Greenville, SC, USA
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