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

Zübeyir Bozdağ ,Taner Çiftçi ,Ahmet Türkoğlu ,Abdullah Böyük ,Ömer Uslukaya ,Abdullah Oğuz ,Metehan Gümüş

doi:10.17546/msd.15377

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.

Highlights

The spleen is one of the most commonly injured organs in abdominal trauma
nonoperative management (NOM) had failed in 11 patients (14.3%), and splenectomy was performed
NOM is the standard treatment for treating hemodynamically stable patients with splenic trauma without additional traumas which require laparotomy

Summary

Introduction

The spleen is one of the most commonly injured organs in abdominal trauma. Historically, the best treatment option for patients with traumatic splenic injury was splenectomy [1]. Hemodynamic instability, age above 55 years, multiple organ injuries, higher splenic trauma grade, Injury Severity Score (ISS) and transfusion requirement, lower blood pressure and GCS at admission, degree of hemoperitoneum, and contrast extravasation are patient-related factors frequently reported to be associated with failure of NOM [1, 6]. Vital signs, injury mechanism, Injury Severity Score (ISS), splenic trauma grade, hematologic parameters, Glasgow Coma Scale (GCS) score, transfusion requirements, and length of hospital stay were recorded. This data was compared between two groups which were defined as Group 1; patients were successfully treated with NOM and Group 2; patients requiring operation due to the failure of NOM. A p < 0.05 was accepted as being statistically significant

Results

Discussion

Conclusion