Safety of selective nonoperative management for blunt splenic trauma: The impact of concomitant injuries

被引：12

作者：

Teuben M.P.J. ^{[1
]}

Spijkerman R. ^{[1
]}

Blokhuis T.J. ^{[2
]}

Pfeifer R. ^{[3
]}

Teuber H. ^{[3
]}

Pape H.-C. ^{[3
]}

Leenen L.P.H. ^{[1
]}

机构：

[1] Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht

[2] Department of Surgery, Maastricht University Medical Center, P. Debyelaan 24, Maastricht

[3] Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zürich

来源：

Patient Safety in Surgery | / 12卷 / 1期

关键词：

Abdominal trauma; Blunt splenic injury; Concurrent injuries; Nonoperative management;

D O I：

10.1186/s13037-018-0179-8

中图分类号：

学科分类号：

摘要：

Background: Nonoperative management for blunt splenic injury is the preferred treatment. To improve the outcome of selective nonoperative therapy, the current challenge is to identify factors that predict failure. Little is known about the impact of concomitant injury on outcome. Our study has two goals. First, to determine whether concomitant injury affects the safety of selective nonoperative treatment. Secondly we aimed to identify factors that can predict failure. Methods: From our prospective trauma registry we selected all nonoperatively treated adult patients with blunt splenic trauma admitted between 01.01.2000 and 12.21.2013. All concurrent injuries with an AIS ≥ 2 were scored. We grouped and compared patients sustaining solitary splenic injuries and patients with concomitant injuries. To identify specific factors that predict failure we used a multivariable regression analysis. Results: A total of 79 patients were included. Failure of nonoperative therapy (n = 11) and complications only occurred in patients sustaining concomitant injury. Furthermore, ICU-stay as well as hospitalization time were significantly prolonged in the presence of associated injury (4 versus 13 days,p < 0.05). Mortality was not seen. Multivariable analysis revealed the presence of a femur fracture and higher age as predictors of failure. Conclusions: Nonoperative management for hemodynamically normal patients with blunt splenic injury is feasible and safe, even in the presence of concurrent (non-hollow organ) injuries or a contrast blush on CT. However, associated injuries are related to prolonged intensive care unit- and hospital stay, complications, and failure of nonoperative management. Specifically, higher age and the presence of a femur fracture are predictors of failure. © 2018 The Author(s).

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