학술논문
Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study.
Document Type
article
Author
Spoor, Kristen; Cull, John; Otaibi, Banan; Hazelton, Joshua; Chipko, John; Reynolds, Jessica; Fugate, Sam; Pederson, Claire; Zier, Linda; Jacobson, Lewis; Williams, Jamie; Easterday, Thomas; Byerly, Saskya; Mentzer, Caleb; Hawke, Edward; Cullinane, Daniel; Ontengco, Julianne; Bugaev, Nikolay; LeClair, Madison; Udekwu, Pascal; Josephs, Cooper; Noorbaksh, Matthew; Babowice, James; Velopulos, Catherine; Urban, Shane; Goldenberg, Anna; Ghobrial, Gaby; Pickering, John; Quarfordt, Steven; Aunchman, Alia; LaRiccia, Aimee; Spalding, Chance; Catalano, Richard; Basham, Jordan; Edmundson, Philip; Tay, Erika; Norwood, Scott; Meadows, Katelyn; Wong, Yee; Hardman, Claire; Nahmias, Jeffry
Source
Trauma Surgery and Acute Care Open. 9(1)
Subject
Language
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.