Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management

  • Na, Joung Won (Department of Surgery, Gachon University Gil Medical Center) ;
  • Lee, Jung Nam (Gachon University Gil Hospital Trauma Center) ;
  • Yu, Byung Chul (Gachon University Gil Hospital Trauma Center) ;
  • Lee, Min A (Gachon University Gil Hospital Trauma Center) ;
  • Park, Jae Jung (Gachon University Gil Hospital Trauma Center) ;
  • Lee, Gil Jae (Gachon University Gil Hospital Trauma Center)
  • Received : 2017.06.07
  • Accepted : 2017.07.28
  • Published : 2017.09.30
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Abstract

Purpose: Purpose: The prognostic factors of non-operative management (NOM) in high-grade spleen injuries have been extensively studied, but factors that would help treatment decisions are lacking. We compared the characteristics of the patients to identify the factors affecting treatment choices. Methods: This is a review of 207 blunt spleen injury patients from January 2004 to December 2013. We compared clinical features and mortality between surgery and NOM, and used multivariate regression analysis to find the factor most strongly associated with prognosis. Results: Of the 207 patients, 107 had high-grade spleen injury patents (grade III or above). Of these, 42 patients underwent surgery and 65 patients underwent NOM. The mortality was 7% following surgery, 3% with NOM. The amount of packed red blood cells transfused in the first 24 hours and spleen injury grade were associated with management type, and mortality was highly associated with activated partial thromboplastin time (aPTT) and spleen injury grade. Conclusions: The grade of spleen injury was associated with management and mortality, so correctly assessing the spleen injury grade is important.

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References

  1. Davis JJ, Cohn I Jr, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg 1976;183:672-8. https://doi.org/10.1097/00000658-197606000-00009
  2. Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012;73(5 Suppl 4):S294-300. https://doi.org/10.1097/TA.0b013e3182702afc
  3. Wani MA, Shah M, Malik AA. Non-operative treatment of splenic injury in patients with blunt abdominal trauma. Int Surg J 2017;4:278-81.
  4. Hildebrand DR, Ben-Sassi A, Ross NP, Macvicar R, Frizelle FA, Watson AJ. Modern management of splenic trauma. BMJ 2014;348:g1864. https://doi.org/10.1136/bmj.g1864
  5. Olthof DC, Joosse P, van der Vlies CH, de Haan RJ, Goslings JC. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 2013;74:546-57. https://doi.org/10.1097/TA.0b013e31827d5e3a
  6. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma 989;29:1664-6.
  7. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995;38:323-4. https://doi.org/10.1097/00005373-199503000-00001
  8. Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008;207:646-55. https://doi.org/10.1016/j.jamcollsurg.2008.06.342
  9. Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. Comparisons of the outcome prediction performance of injury severity scoring tools using the abbreviated injury scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008). Ann Adv Automot Med 2011;55:255-65.
  10. Lesko MM, Woodford M, White L, O'Brien SJ, Childs C, Lecky FE. Using Abbreviated Injury Scale (AIS) codes to classify computed tomography (CT) features in the Marshall System. BMC Med Res Methodol 2010;10:72. https://doi.org/10.1186/1471-2288-10-72
  11. Rosati C, Ata A, Siskin GP, Megna D, Bonville DJ, Stain SC. Management of splenic trauma: a single institution's 8-year experience. Am J Surg 2015;209:308-14. https://doi.org/10.1016/j.amjsurg.2014.06.034
  12. Powell M, Courcoulas A, Gardner M, Lynch J, Harbrecht BG, Udekwu AO, et al. Management of blunt splenic trauma: significant differences between adults and children. Surgery 1997;122:654-60. https://doi.org/10.1016/S0039-6060(97)90070-2
  13. Aseervatham R, Muller M. Blunt trauma to the spleen. ANZ Journal of Surgery. 2000;70:333-7. https://doi.org/10.1046/j.1440-1622.2000.01821.x
  14. Watson GA, Rosengart MR, Zenati MS, Tsung A, Forsythe RM, Peitzman AB, et al. Nonoperative management of severe blunt splenic injury: are we getting better? Aust N Z J Surg 2006;61:1113-9.
  15. Peitzman AB, Heil B, Rivera L, Federle MB, Harbrecht BG, Clancy KD, et al. Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma 2000;49:177-87; discussion 187-9. https://doi.org/10.1097/00005373-200008000-00002
  16. Scarborough JE, Ingraham AM, Liepert AE, Jung HS, O'Rourke AP, Agarwal SK. Nonoperative management is as effective as immediate splenectomy for adult patients with high-grade blunt splenic injury. J Am Coll Surg 2016;223:249-58. https://doi.org/10.1016/j.jamcollsurg.2016.03.043
  17. Olthof DC, Joosse P, Bossuyt PM, de Rooij PP, Leenen LP, Wendt KW, et al. Observation versus embolization in patients with blunt splenic injury after trauma: a propensity score analysis. World J Surg 2016;40:1264-71. https://doi.org/10.1007/s00268-015-3387-8
  18. Watson G, Hoffman M, Peitzman A. Nonoperative management of blunt splenic injury: what is new? Eur J Trauma Emerg Surg 2015;41:219-28. https://doi.org/10.1007/s00068-015-0520-1
  19. Sondeen JL, Prince MD, Kheirabadi BS, Wade CE, Polykratis IA, de Guzman R, et al. Initial resuscitation with plasma and other blood components reduced bleeding compared to hetastarch in anesthetized swine with uncontrolled splenic hemorrhage. Transfusion 2011;51:779-92. https://doi.org/10.1111/j.1537-2995.2010.02928.x
  20. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernandez-Mondejar E, et al. Management of bleeding following major trauma: an updated European guideline. Crit Care 2010;14:R52. https://doi.org/10.1186/cc8943
  21. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernandez-Mondejar E, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 2016;20:100. https://doi.org/10.1186/s13054-016-1265-x
  22. Gaarder C, Dormagen JB, Eken T, Skaga NO, Klow NE, Pillgram-Larsen J, et al. Nonoperative management of splenic injuries: improved results with angioembolization. J Trauma 2006;61:192-8. https://doi.org/10.1097/01.ta.0000223466.62589.d9
  23. Leeper WR, Leeper TJ, Ouellette D, Moffat B, Sivakumaran T, Charyk-Stewart T, et al. Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma: early screening leads to a decrease in failure rate. J Trauma Acute Care Surg 2014;76:1349-53. https://doi.org/10.1097/TA.0000000000000228
  24. Muroya T, Ogura H, Shimizu K, Tasaki O, Kuwagata Y, Fuse T, et al. Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury: multi-institutional study in Osaka, Japan. J Trauma Acute Care Surg 2013;75:417-20. https://doi.org/10.1097/TA.0b013e31829fda77
  25. Bruce PJ, Helmer SD, Harrison PB, Sirico T, Haan JM. Nonsurgical management of blunt splenic injury: is it cost effective? Am J Surg 2011;202:810-6; discussion 815-6. https://doi.org/10.1016/j.amjsurg.2011.06.041