TY - JOUR
T1 - Blunt Splenic Injury in Adults
T2 - Multi-institutional Study of the Eastern Association for the Surgery of Trauma
AU - Peitzman, Andrew B.
AU - Heil, Brian
AU - Rivera, Louis
AU - Federle, Michael B.
AU - Harbrecht, Brian G.
AU - Clancy, Keith D.
AU - Croce, Martin
AU - Enderson, Blaine L.
AU - Morris, John A.
AU - Shatz, David
AU - Meredith, J. Wayne
AU - Ochoa, Juan B.
AU - Fakhry, Samir M.
AU - Cushman, James G.
AU - Minei, Joseph P.
AU - McCarthy, Mary
AU - Luchette, Fred A.
AU - Townsend, Ricard
AU - Tinkoff, Glenn
AU - Block, Ernest F.J.
AU - Ross, Steven
AU - Frykberg, Eric R.
AU - Bell, Richard M.
AU - Davis, Frank
AU - Weireter, Leonard
AU - Shapiro, Michael B.
AU - Kealey, G. Patrick
AU - Rogers, Fred
AU - Jones, Larry M.
AU - Cone, John B.
AU - Dunham, C. Michael
AU - McAuley, Clyde E.
PY - 2000
Y1 - 2000
N2 - BACKGROUND: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. METHODS: A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended chi2 test. Data are expressed as mean +/- SD; a value of p < 0.05 was considered significant. RESULTS: A total of 38.5 % of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) < 15 and 46.6% of patients with ISS > 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p < 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4% of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. CONCLUSION: In this multicenter study, 38.5% of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.
AB - BACKGROUND: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. METHODS: A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended chi2 test. Data are expressed as mean +/- SD; a value of p < 0.05 was considered significant. RESULTS: A total of 38.5 % of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) < 15 and 46.6% of patients with ISS > 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p < 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4% of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. CONCLUSION: In this multicenter study, 38.5% of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.
KW - Adult
KW - Critical Care / statistics & numerical data
KW - Female
KW - Glasgow Coma Scale
KW - Humans
KW - Male
KW - Retrospective Studies
KW - Societies, Medical
KW - Spleen / injuries
KW - Spleen / surgery
KW - Splenectomy / statistics & numerical data
KW - Trauma Severity Indices
KW - United States / epidemiology
KW - Wounds, Nonpenetrating / epidemiology
KW - Wounds, Nonpenetrating / surgery
KW - Multicenter Study
UR - http://www.scopus.com/inward/record.url?scp=0033821154&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033821154&partnerID=8YFLogxK
UR - https://corescholar.libraries.wright.edu/surg/561
U2 - 10.1097/00005373-200008000-00002
DO - 10.1097/00005373-200008000-00002
M3 - Article
C2 - 10963527
SN - 0022-5282
VL - 49
SP - 177
EP - 189
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 2
ER -