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Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centers with Low Trauma Incidence and in the Presence of Established Risk Factors

Norrman, Gustav; Tingstedt, Bobby LU ; Ekelund, Mikael LU and Andersson, Roland LU (2009) In European Journal of Trauma and Emergency Surgery 35(2). p.102-107
Abstract
Background: Treatment of blunt splenic trauma has undergone dramatic changes over the last few decades. Nonoperative management (NOM) is now the preferred treatment of choice, when possible. The outcome of NOM has been evaluated. This study evaluates the results following the management of blunt splenic injury in adults in a Swedish university hospital with a low blunt abdominal trauma incidence. Method: Fifty patients with blunt splenic trauma were treated at the Department of Surgery, Lund University Hospital from January 1994 to December 2003. One patient was excluded due to a diagnostic delay of > 24 h. Charts were reviewed retrospectively to examine demographics, injury Severity score (ISS), splenic injury grade, diagnostics,... (More)
Background: Treatment of blunt splenic trauma has undergone dramatic changes over the last few decades. Nonoperative management (NOM) is now the preferred treatment of choice, when possible. The outcome of NOM has been evaluated. This study evaluates the results following the management of blunt splenic injury in adults in a Swedish university hospital with a low blunt abdominal trauma incidence. Method: Fifty patients with blunt splenic trauma were treated at the Department of Surgery, Lund University Hospital from January 1994 to December 2003. One patient was excluded due to a diagnostic delay of > 24 h. Charts were reviewed retrospectively to examine demographics, injury Severity score (ISS), splenic injury grade, diagnostics, treatment and outcome measures. Results: Thirty-nine patients (80%) were initially treated nonoperatively (NOM), and ten (20%) patients underwent immediate surgery (operative management, OM). Only one (3%) patient failed NOM and required surgery nine days after admission (failure of NOM, FNOM). The patients in the OM group had higher ISS (p < 0.001), higher grade of splenic injury (p < 0.001), and were hemodynamically unstable to a greater extent (p < 0.001). This was accompanied by increased transfusion requirements (p < 0.001), longer stay in the ICU unit (p < 0.001) and higher costs (p = 0.001). Twenty-seven patients were successfully treated without surgery. No serious complication was found on routine radiological follow-up. Conclusion: Most patients in this study were managed conservatively with a low failure rate of NOM. NOM of blunt splenic trauma could thus be performed in a seemingly safe and effective manner, even in the presence of established risk factors. Routine follow-up with CT scan did not appear to add clinically relevant information affecting patient management. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Risk factors, Blunt splenic trauma, Nonoperative management, Outcome
in
European Journal of Trauma and Emergency Surgery
volume
35
issue
2
pages
102 - 107
publisher
Urban & Vogel
external identifiers
  • wos:000265340900004
  • pmid:26814761
  • scopus:67349108779
ISSN
1863-9933
DOI
10.1007/s00068-008-8108-7
language
English
LU publication?
yes
id
6dd7d624-ea0b-407c-a791-309f501d4384 (old id 1399557)
date added to LUP
2009-06-15 15:20:17
date last changed
2017-01-01 04:56:40
@article{6dd7d624-ea0b-407c-a791-309f501d4384,
  abstract     = {Background: Treatment of blunt splenic trauma has undergone dramatic changes over the last few decades. Nonoperative management (NOM) is now the preferred treatment of choice, when possible. The outcome of NOM has been evaluated. This study evaluates the results following the management of blunt splenic injury in adults in a Swedish university hospital with a low blunt abdominal trauma incidence. Method: Fifty patients with blunt splenic trauma were treated at the Department of Surgery, Lund University Hospital from January 1994 to December 2003. One patient was excluded due to a diagnostic delay of &gt; 24 h. Charts were reviewed retrospectively to examine demographics, injury Severity score (ISS), splenic injury grade, diagnostics, treatment and outcome measures. Results: Thirty-nine patients (80%) were initially treated nonoperatively (NOM), and ten (20%) patients underwent immediate surgery (operative management, OM). Only one (3%) patient failed NOM and required surgery nine days after admission (failure of NOM, FNOM). The patients in the OM group had higher ISS (p &lt; 0.001), higher grade of splenic injury (p &lt; 0.001), and were hemodynamically unstable to a greater extent (p &lt; 0.001). This was accompanied by increased transfusion requirements (p &lt; 0.001), longer stay in the ICU unit (p &lt; 0.001) and higher costs (p = 0.001). Twenty-seven patients were successfully treated without surgery. No serious complication was found on routine radiological follow-up. Conclusion: Most patients in this study were managed conservatively with a low failure rate of NOM. NOM of blunt splenic trauma could thus be performed in a seemingly safe and effective manner, even in the presence of established risk factors. Routine follow-up with CT scan did not appear to add clinically relevant information affecting patient management.},
  author       = {Norrman, Gustav and Tingstedt, Bobby and Ekelund, Mikael and Andersson, Roland},
  issn         = {1863-9933},
  keyword      = {Risk factors,Blunt splenic trauma,Nonoperative management,Outcome},
  language     = {eng},
  number       = {2},
  pages        = {102--107},
  publisher    = {Urban & Vogel},
  series       = {European Journal of Trauma and Emergency Surgery},
  title        = {Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centers with Low Trauma Incidence and in the Presence of Established Risk Factors},
  url          = {http://dx.doi.org/10.1007/s00068-008-8108-7},
  volume       = {35},
  year         = {2009},
}