The World Society of Emergency Surgery (WSES) spleen trauma classification: a useful tool in the management of splenic trauma

Federico Coccolini,Luca Ansaloni,Paola Fugazzola,Marco Ceresoli,Yoram Kluger,Stefano Magnone,Lucia Morganti,Niccolò Allievi,Giulia Montori,Stefano Maccatrozzo,Matteo Tomasoni,Massimo Sartelli,Fausto Catena,Savino Occhionorelli,Gian Luca Baiocchi

doi:10.1186/s13017-019-0246-1

Abstract

BackgroundThe World Society of Emergency Surgery (WSES) spleen trauma classification meets the need of an evolution of the current anatomical spleen injury scale considering both the anatomical lesions and their physiologic effect. The aim of the present study is to evaluate the efficacy and trustfulness of the WSES classification as a tool in the decision-making process during spleen trauma management.MethodsMulticenter prospective observational study on adult patients with blunt splenic trauma managed between 2014 and 2016 in two Italian trauma centers (ASST Papa Giovanni XXIII in Bergamo and Sant’Anna University Hospital in Ferrara). Risk factors for operative management at the arrival of the patient and as a definitive treatment were analyzed. Moreover, the association between the different WSES grades of injury and the definitive management was analyzed.ResultsOne hundred twenty-four patients were included. At multivariate analysis, a WSES splenic injury grade IV is a risk factor for the operative management both at the arrival of the patients and as a definitive treatment. WSES splenic injury grade III is a risk factor for angioembolization.ConclusionsThe WSES classification is a good and reliable tool in the decision-making process in splenic trauma management.

Highlights

The most commonly used classification of splenic trauma is the American Association for the Surgery of Trauma (AAST)-Organ Injury Severity Score (OIS)
The aim of the present study is to evaluate the efficacy and trustfulness of the World Society of Emergency Surgery (WSES) classification as a tool in decision-making process during spleen trauma management
Among OM patients, we had 84.5% (49 patients) of patients treated with splenectomy and 15.5% (9 patients) with hepatic and splenic packing and/or splenic hemostasis (Table 2)

Summary

Introduction

The most commonly used classification of splenic trauma is the American Association for the Surgery of Trauma (AAST)-Organ Injury Severity Score (OIS). Coccolini et al World Journal of Emergency Surgery (2019) 14:30 the physiopathologic status of the patients leads the therapeutic decision, more than the anatomy of the splenic lesions. There are patients with high-grade splenic lesions without hemodynamic repercussions that can be managed with NOM thanks to the modern tools in bleeding management. There exists a cohort of patients with hemodynamic instability requiring urgent surgical intervention due to low-grade splenic injuries. The World Society of Emergency Surgery (WSES) spleen trauma classification meets the need of an evolution of the current anatomical spleen injury scale considering both the anatomical lesions and their physiologic effect. The aim of the present study is to evaluate the efficacy and trustfulness of the WSES classification as a tool in the decision-making process during spleen trauma management

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Discussion

Conclusion