Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

Abstract

Objective:  It is crucial to assess non-operative management (NOM) of risk failures before it is preferred as a management option for treatment of splenic trauma or rupture. The purpose of this study is to investigate the outcome of non-operative management of splenic trauma, and to determine the independent predictive factors effecting NOM failure. Material and Methods: Seventy-seven patients among all of consecutive patients admitted with splenic trauma between January 2005 and June 2015 were included in the study. The patients were divided into two groups. Group 1: Successfully treated with non-operative management, and Group 2: The failure of non-operative management. Data recorded included patient demographics, vital signs, injury mechanism, Injury Severity Score (ISS), splenic trauma grade, hematologic parameters, Glasgow Coma Scale (GCS), transfusion requirements, and length of hospital stay. Results: There were 66 (85.7 %) patients in group 1, while only 11 patients (14.3%) in group 2. Mechanism of injury was blunt in seventy-one patients and, penetrating in 6 patients. ISS [Odds Ratio=1.293; 95% CI=1.045-1.601; p=0.018] and blood transfusion [Odds Ratio=2,739; 95% CI= 1.140-6,581; p=0.024] were detected to be an independent predictive factors for the failure of non-operative management. Group 1 has significantly higher hospitalization period (7.73±2.867 vs 6.67±2.289). Conclusions: Non-operative management failure risk is crucial and higher in patients with high ISS and in patients who require much blood transfusion in first 24 hours. Special attention should be paid to these patients if non-operative management becomes the preferred management option.

Keywords

• nonoperative management, predictivity, splenic trauma

Independent risk factors for failure of non-operative management in patients with splenic injury

Öz

References

1. 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 trauma: a systematic review. J Trauma Acute Care Surg. 2013;74 :546-57.
2. Singer DB. Post-splenectomy sepsis. Perspect Pediatr Pathol 1973;1: 285–311.
3. Galvan DA, Peitzman AB. Failure of nonoperative management of abdominal solid organ injuries. Curr Opin Crit Care. 2006;12:590-4.
4. Watson GA, Rosengart MR, Zenati MS, et al. Nonoperative management of severe blunt splenic trauma: are we getting better? J Trauma. 2006;61:1113-8; discussion 1118-9.
5. Smith J, Armen S, Cook CH, Martin LC. Blunt splenic trauma: have we watched long enough? J Trauma. 2008;64:656-63. discussion 663-5
6. Tugnoli G, Bianchi E, Biscardi A, et al. Nonoperative management of blunt splenic trauma in adults: there is (still) a long way to go. The results of the Bologna-Maggiore Hospital trauma center experience and development of a clinical algorithm. Surg Today. 2014 Dec 5. [Epub ahead of print]
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
8. Notash AY, Amoli HA, Nikandish A, Kenari AY, Jahangiri F, Khashayar P. Non-operative management in blunt splenic trauma. Emerg Med J. 2008;25:210-2

9. 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. doi: 10.1016/j.amjsurg.2014.06.034. Epub 2014 Oct 7
10. Böyük A, Gümüş M, Önder A, et al. Splenic injuries: factors affecting the outcome of non- operative management. European Journal of Trauma and Emergency Surgery. June 2012;38:269-74
11. Gonzalez M, Bucher P, Ris F, Andereggen E, Morel P. Splenic trauma: predictive factors for failure of non-operative management [in French]. J Chir (Paris). 2008;145:561-7.
12. Jeremitsky E, Kao A, Carlton C, Rodriguez A, Ong A. Does splenic embolization and grade of splenic trauma impact nonoperative management in patients sustaining blunt splenic trauma? Am Surg. 2011;77:215-20.
13. Nix JA, Costanza M, Daley BJ, Powell MA, Enderson BL. Outcome of the current management of splenic trauma. J Trauma. 2001;50:835-42.
14. Velmahos GC, Chan LS, Kamel E, et al. Nonoperative management of splenic trauma: have we gone too far? Arch Surg. 2000;135:674–9.
15. Sharma OP, Oswanski MF, Singer D, Raj SS, Daoud YA. Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg. 2005;71:379–86.
16. Sartorelli KH, Frumiento C, Rogers FB, Osler TM. Nonoperative management of hepatic, splenic, and renal injuries in adults with multiple injuries. J Trauma. 2000;49:56-61; discussion 61-2
17. Hsieh TM, Cheng Tsai T, Liang JL, Che Lin C. Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy. World J Emerg Surg. 2014:25;9:51. doi: 10.1186/1749-7922-9-51. eCollection 2014
18. Ochsner MG. Factors of failure for nonoperative management of blunt liver and splenic injuries. World J Surg. 2001;25:1393–6
19. McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg. 2005;140:563–8; discussion 568–9
20. Bala M, Edden Y, Mintz Y, et al. Blunt splenic trauma: predictors for successful non-operative management. Isr Med Assoc J. 2007;9:857–61.
21. Rodrigues CJ, Sacchetti JC, Rodrigues AJ Jr. Age-related changes in the elastic fiber network of the human splenic capsule. Lymphology. 1999;32:64–9.
22. Renzulli P, Gross T, Schnüriger B, et al. Management of blunt injuries to the spleen.Br J Surg. 2010;97:1696-703. doi: 10.1002/bjs.7203
23. Pal JD, Victorino GP. Defining the role of computed tomography in blunt abdominal trauma.Use in the hemodynamically stable patient with a depressed level of consciousness. Arch Surg. 2002;137:1029-33.
24. Sosada K, Wiewióra M, Piecuch J. Literature review of non-operative management of patients with blunt splenic trauma: impact of splenic artery embolization.Wideochir Inne Tech Maloinwazyjne. 2014;9:309-14. doi: 10.5114/wiitm.2014.44251. Epub 2014 Jul 23.
25. Meguid AA, Bair HA, Howells GA, Bendick PJ, Kerr HH, Villalba MR. Prospective evaluation of criteria for the nonoperative management of blunt splenic trauma. Am Surg. 2003;69:238-42.
26. Berg RJ, Inaba K, Okoye O, et al. The contemporary management of penetrating splenic trauma. Injury. 2014 Sep;45:1394-400. doi: 10.1016/j.injury.2014.04.025. Epub 2014 Apr 18.
27. Schurr MJ, Fabian TC, Gavant M, et al. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma. 1995;39:507-12; discussion 512-3
28. Bee TK, Croce MA, Miller PR, Pritchard FE, Fabian TC. Failures of splenic nonoperative management: is the glass half empty or half full? J Trauma. 2001;50:230–6.
29. Malhotra AK, Latifi R, Fabian TC, et al. Multiplicity of solid organ injury: influence on management and outcomes after blunt abdominal trauma. J Trauma. 2003;54:925-9.
30. Demetriades D, Hadjizacharia P, Constantinou C, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244: 620–8.
31. Beuran M, Gheju I, Venter MD, Marian RC, Smarandache R. Non-operative management of splenic trauma.Med Life. 2012 Feb 22;5(1):47-58. Epub 2012 Mar 5.
32. Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg. 1998;227:708–17.
33. Harbrecht BG. Is anything new in adult blunt splenic trauma? Am J Surg. 2005; 190:273-8.