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Abstract
Purpose
We describe clinical outcomes of NOM on spleen injuries with judicious selection and embolization during the past 10 years.
Methods
From March 2000 to November 2009, 151 patients with splenic injury were included. Eighteen patients were excluded because of incomplete data. Patients' medical records were reviewed to examine admission demographics, laboratory results, radiologic findings as well as transfusion requirement, hospital stay, and ultimate outcomes.
Results
Twenty patients were chosen for non-operative management (NOM) after splenic embolization and 1/20 (5%) patient failed. There were 32 patients more than 55 years old (range, 55∼87 years). Of these patients, 26 (81%) patients were chosen for NOM and 3 (11.5%) patients failed. According to OIS, 51 patients were grade 3; 26 patients, grade 4; and 6 patients, grade 5. Among grade 3, 49 (96%) were chosen for NOM with or without embolization and 1 (2%) patient failed; grade 4, 19 (73%) with NOM, 2 (7.6%) patients failed. Of all 133 patients with NOM or failed NOM (FNOM), there was 0 mortality in grade 3; 2, in grade 4; 2, in grade 5, excluding other causes of death. The mean ISS was significantly higher in the failed NOM group compared with successful NOM group (P=0.01). The group of failed NOM had a significantly higher mean OIS (P=0.00).
References
1. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg. 2000; 231:804–13.
2. Schwab CW. Selection of nonoperative management candidates. World J Surg. 2001; 25:1389–92.
3. Rutledge R. The increasing frequency of nonoperative management of patients with liver and splenic injuries. Adv Surgery. 1996; 30:385–415.
4. Cogbill TH, Moore EE, Jurkovich GJ, Morris JA, Mucha P Jr, Shackford SR, et al. Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma. 1989; 29:1312–7.
5. McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries; cause and consequence. Arch Surg. 2005; 140:563–8.
6. Cocanour CS, Moore FA, Ware DN, Marvin RG, Duke JH. Age should not be a consideration for nonoperative management of blunt splenic injury. J Trauma. 2000; 48:606–10.
7. Baker SP, O'Neill B, Hadden W, Long WB. The injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14:187–97.
8. Morris DH, Bullock FD. The importance of the spleen in resistance to infection. Ann Surg. 1919; 70:513–21.
9. King H, Shumacker HB. Splenic studies. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952; 136:239–42.
10. Douglas GJ, Simpson JS. The conservative management of splenic trauma. J Pediatr Surg. 1971; 6:565–70.
11. Myers JG, Dent DL, Stewart RM, Gray GA, Smith DS, Rhodes JE, et al. Blunt splenic injuries: Dedicated Trauma surgeons can achieve a high rate of nonoperative success in patients of all ages. J Trauma. 2000; 48:801–5.
12. Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma. 2008; 64:943–8.
13. Townsend CM Jr, Daniel BR, Mark EB, Mattox KL. Sabiston Textbook of Surgery; The Biological Basis of Modern Surgical Practice. 18th ed.Philadelphia: Saunders;2007.
14. Tominaga GT, Simon FJ Jr, Dandan IS, Schaffer KB, Kraus JF, Kan M, et al. Immunologic function after splenic embolization. Is there a difference? J Trauma. 2009; 67:289–95.
15. Nix JA, Costanza M, Daley BJ, Powell MA, Enderson BL. Outcome of the current management of splenic injuries. J Trauma. 2001; 50:835–42.
16. Cho YP, Jung SM, Han MS, Jang HJ, Kim YH, Choi YB. Repeat CT scan for non-operative management of blunt splenic trauma. J Korean Surg Soc. 2004; 67:390–6.
Table 1.
Patient demographics and relevant clinical data
Table 2.
Comparison of the clinical data of the OP and SNOM groups
| Variable | OP*-group (n=13) | SNOM† group (n=113) | P |
|---|---|---|---|
| Mean age | 45.4±5.0 | 36.1±2.0 | 0.139 |
| Above 55 years old | 5 | 23 | 0.383 |
| Injury severity scale | 22.6±3.6 | 21.6±1.3 | 0.803 |
| Glasgow coma scale | 0.656 | ||
| Organ injury scale | 3.8±0.3 | 2.7±0.1 | 0.000 |
| Hospital stay (day) | 24.5±5.4 | 24.6±2.4 | 0.988 |
| Transfusion (ml) | 3,286.2±744.1 | 1,353.2±333.3 | 0.059 |
| Initial systolic BP | 100±10.1 | 107.7±2.2 | 0.280 |
| Initial heart rate | 90.2±4.8 | 92.9±2.3 | 0.695 |
Table 3.
Comparison of the clinical data of the SNOM and FNOM groups
| Variable | SNOM group (n=113) | FNOM* group (n=5) | P |
|---|---|---|---|
| Mean age | 36.1±2.0 | 54.6±13.4 | 0.068 |
| Above 55 years old | 23 | 3 | 0.070 |
| Injury severity scale | 21.6±1.3 | 37.6±6.4 | 0.01 |
| Glasgow coma scale | 0.07 | ||
| Organ injury scale | 2.7±0.1 | 4.0±0.3 | 0.00 |
| Hospital stay | 24.6±2.4 | 10.6±5.3 | 0.22 |
| Transfusion | 1,353.2±333.3 | 3,920.0±1,306.9 | 0.11 |
| Initial systolic BP | 107.7±2.2 | 97.0±10.2 | 0.29 |
| Initial heart rate | 92.9±2.3 | 93.6±7.1 | 0.94 |
Table 4.
Comparison the clinical data of members of the OP and SNOM groups that underwent angioembolization
| Variable | OP*-group (n=13) | SNOM† group with embolization (n=18) | P |
|---|---|---|---|
| Mean age | 45.4±5.0 | 47.8±4.8 | 0.739 |
| 55 years old | 5 | 23 | |
| Injury severity scale | 22.6±3.6 | 30.0±3.5 | 0.166 |
| Glasgow coma scale | 0.619 | ||
| Organ injury scale | 3.8±0.3 | 3.6±0.1 | 0.592 |
| Hospital stay | 24.5±5.4 | 27.3±6.6 | 0.763 |
| Transfusion | 3,286.2±744.1 | 3,506.7±1,758.7 | 0.920 |
| Initial systolic BP | 100±10.1 | 95.6±5.9 | 0.689 |
| Initial heart rate | 90.2±4.8 | 98.7±5.6 | 0.274 |
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