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).
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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 |