Abstract
BackgroundThere is growing evidence of clinical data recently for successful outcomes of non-operative management (NOM) for blunt hepatic and spleen injuries (BHSI). However, the effectiveness of NOM for high-grade BHSI remains undefined. The aim of the present study was to review our experience with NOM in high-grade BHSI and compare results with the existing related data worldwide.MethodsIn this retrospectively protocol-driven study, 150 patients with grade 3–5 BHSI were enrolled during a 3-year period. Patients were divided into immediate laparotomy (immediate OP) and initial non-operative (initial NOM) groups according to hemodynamic status judged by duty trauma surgeon. Patients who received initial NOM were divided into successful NOM (s-NOM) and failed NOM (f-NOM) subgroups according to conservative treatment failure. We analyzed the clinical characteristics and the outcomes of patients.ResultsTwenty-eight (18.7%) patients underwent immediate operations, and the remaining 122 (81.3%) were initially treated with NOM. Compared with the initial NOM group, the immediate OP group had significantly lower hemoglobin levels, a higher incidence of tube thoracostomy, contrast extravasation and large hemoperitoneum on computed tomography, a higher injury severity score, increased need for transfusions, and longer length of stay (LOS) in the intensive care unit (ICU) and hospitalization. Further analysis of the initial NOM group indicated that NOM had failed in 6 (4.9%) cases. Compared with the s-NOM subgroup, f-NOM patients had significantly lower hemoglobin levels, more hospitalized transfusions, and longer ICU LOS.ConclusionsNOM of high-grade BHSI in selected patients is a feasible strategy. Notwithstanding, patients with initial low hemoglobin level and a high number of blood transfusions in the ICU are associated with a high risk for NOM failure.
Highlights
Blunt abdominal trauma (BAT) resulting from a traffic accident, fall, assault, or occupational accident is not unusual in the emergency room
Because few studies have focused exclusively on high-grade blunt hepatic and spleen injuries (BHSI), the present study aimed to investigate the efficacy of non-operative management (NOM) for complex BHSI in the setting of a tertiary care center
Trauma mechanisms During the 3-year study period, 150 patients presented with high-grade BHSI, of whom 91 and 59 had blunt hepatic injurIES (BHI) and blunt spleinc injuries (BSI), respectively
Summary
Blunt abdominal trauma (BAT) resulting from a traffic accident, fall, assault, or occupational accident is not unusual in the emergency room. As the concept of NOM is established, there is a growing concern regarding its morbidity and drawbacks of angioembolization, which are especially prevalent in high-grade injuries [14,15,16,17,18]. The effectiveness of NOM in high-grade injuries is still under scrutiny. Because few studies have focused exclusively on high-grade BHSI, the present study aimed to investigate the efficacy of NOM for complex BHSI in the setting of a tertiary care center. There is growing evidence of clinical data recently for successful outcomes of non-operative management (NOM) for blunt hepatic and spleen injuries (BHSI). The effectiveness of NOM for high-grade BHSI remains undefined. The aim of the present study was to review our experience with NOM in high-grade BHSI and compare results with the existing related data worldwide
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