Blunt Spleen Injury Research Articles

Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study

Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study

Assessing associated factors for failure of nonoperative management in pediatric blunt liver and spleen injuries: a secondary analysis of the SHIPPs study.

The purpose of this study was to describe the characteristics of pediatric patients who underwent nonoperative management (NOM) for blunt splenic and hepatic injuries and to explore factors associated with NOM failure. This was a secondary analysis of a multicenter cohort study of pediatric patients with blunt liver and spleen injuries in Japan. Participants included pediatric trauma patients aged 16years or younger between 2008 and 2019 with NOM, which was defined as no surgery provided within 6h of hospital arrival. NOM failure, defined as abdominal surgery performed after 6h of hospital arrival, was the primary outcome. Descriptive statistics were provided and exploratory analysis to assess the associations with outcome using logistic regression. During the study period, 1339 met our eligibility criteria. The median age was 9years, with a majority being male. The median Injury Severity Score (ISS) was 10. About 14.0% required transfusion within 24h, and 22.3% underwent interventional radiology procedures. NOM failure occurred in 1.0% of patients and the in-hospital mortality was 0.7%. Factors associated with NOM failure included age, positive focused assessment with sonography for trauma (FAST), contrast extravasation on computed tomography (CT), severe liver injury, concomitant pancreas injury, concomitant gastrointestinal injury, concomitant mesenteric injury, and ISS. In our study, NOM failure were rare. Older age, positive FAST, contrast extravasation on CT, severe liver injury, concomitant pancreas injury, concomitant gastrointestinal injury, concomitant mesenteric injury, and higher ISS were suggested as possible risk factors for NOM failure.

Follow-up computed tomography and unexpected hemostasis in non-operative management of pediatric blunt liver and spleen injury.

While follow-up CT and prophylactic embolization with angiography are often conducted during non-operative management (NOM) for BLSI, particularly in a high-grade injury, the utility of early repeated CT for preventing unexpected hemorrhage remains unclear. This study aimed to elucidate whether early follow-up computerized tomography (CT) within 7 days after admission would decrease unexpected hemostatic procedures on pediatric blunt liver and spleen injury (BLSI). A post-hoc analysis of a multicenter observational cohort study on pediatric patients with BLSI (2008-2019) was conducted on those who underwent NOM, in whom the timing of follow-up CT were decided by treating physicians. The incidence of unexpected hemostatic procedure (laparotomy and/or emergency angiography for ruptured pseudoaneurysm) and complications related to BLSI were compared between patients with and without early follow-up CT within 7 days. Inverse probability weighting with propensity scores adjusted patient demographics, comorbidities, mechanism and severity of injury, initial resuscitation, and institutional characteristics. Among 1320 included patients, 552 underwent early follow-up CT. Approximately 25% of patients underwent angiography on the day of admission. The incidence of unexpected hemostasis was similar between patients with and without early repeat CT (8 [1.4%] vs. 6 [0.8%]; adjusted OR, 1.44 [0.62-3.34]; p = 0.40). Patients with repeat CT scans more frequently underwent multiple angiographies (OR, 2.79 [1.32-5.88]) and had more complications related to BLSI, particularly bile leak (OR, 1.73 [1.04-2.87]). Follow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.

Opportunity for Reduction of Intensive Care Unit Resource Utilization in Pediatric Blunt Liver and Spleen Injuries: A National Trauma Data Bank Analysis

IntroductionGuidelines for blunt liver and spleen injury (BLSI) by the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) emphasize hemodynamic stability over injury grade when considering non-operative management (NOM). In this study, we examined rates of intensive care unit (ICU) admission for children with isolated low-risk BLSI among US hospitals. MethodsThe National Trauma Data Bank (NTDB) was queried for patients ages 1-15 admitted between 2017 and 2019 with BLSI. Patients with penetrating injuries and/or concomitant non-abdominal injuries with AIS score ≥3 were excluded. Isolated BLSI was considered low-risk if the patient had normal admission vitals and did not require operative intervention. Primary outcomes measured were ICU admission, ICU length of stay (LOS), and overall LOS. Results5777 patients ages 15 and under presented with isolated BLSI during the study period. 2031/5777 (35.2%) were considered low-risk. Low-risk patients had lower rates of ICU admission compared to high-risk patients (30.9% vs. 41.6%, p < 0.001) and had shorter ICU LOS (median 2 days vs. 2, p < 0.001) and shorter overall LOS (median 41 h vs. 54, p < 0.001). Pediatric verified and non-pediatric verified trauma centers had similar rates of ICU admission (36.8% vs. 38.9%, p = 0.11). ConclusionFurther work is needed to capture opportunities for reduction in ICU utilization in isolated BLSI. Level of EvidenceIII

A protocol-driven approach to reduce lengths of stay for pediatric blunt liver and spleen injury patients.

Our institution updated blunt liver and spleen injury (BLSI) protocols in 2019 in adherence to updated American Pediatric Surgery Association recommendations. This retrospective study compares resource utilization for pediatric BLSI patients treated under old and updated guidelines. Blunt liver and spleen injury patients without severe non-abdomen injuries younger than 18 years treated with prior (April 2015 to June 2019) and updated (June 2019 to December 2022) guidelines were retrospectively reviewed and compared. Each patient received an adjusted Injury Severity Score (ISS) to control for non-BLSI injuries. Multivariate analysis examined protocol group differences while controlling for adjusted ISS and BLSI grades. Primary outcomes were intensive care unit (ICU) length of stay (LOS), hospital LOS (analyzed using Cox regression), and patient costs (linear regression). Secondary outcomes include readmission in 2 weeks and death rates (logistic regression). A total of 176 and 170 BLSI patients were treated with old and updated protocols, respectively. Patient demographics, average BLSI grade, and adjusted ISS were similar in both groups. Patients treated with old protocols indicate decreased hazard, showing significantly more days before ICU discharge (coefficient, -0.3868; p < 0.0009) and hospital discharge (coefficient, -0.5507; p < 0.0001). Patient costs (coefficient, 0.0921; p = 0.1874) trend toward being lower in the new protocol. Readmission rates were significantly higher in the new protocol (coefficient, -1.1731; p = 0.0465), and death rates (coefficient, 0.0519; p = 0.9710) were comparable. Blunt liver and spleen injury patients treated under new American Pediatric Surgery Association guidelines compared with old guidelines had significant decreases in ICU and hospital LOS, a decreasing trend in costs, and comparable death rates but higher readmission rates. Future studies with larger sample sizes and detailed cost analysis would explore whether updated guidelines reduce patient costs and help elucidate the veracity or potential cause of the increased readmission rates. Therapeutic/Care Management; Level III.

The use and timing of angioembolization in pediatric blunt liver and spleen injury.

Nonoperative management (NOM) is the standard of care for the management of blunt liver and spleen injuries (BLSI) in the stable pediatric patient. Angiography with embolization (AE) is used as an adjunctive therapy in the management of adult BLSI patients, but it is rarely used in the pediatric population. In this planned secondary analysis, we describe the current utilization patterns of AE in the management of pediatric BLSI. After obtaining IRB approval at each center, cohort data was collected prospectively for children admitted with BLSI confirmed on CT at 10 Level I pediatric trauma centers (PTCs) throughout the United States from April 2013 to January 2016. All patients who underwent angiography with or without embolization for a BLSI were included in this analysis. Data collected included patient demographics, injury details, organ injured and grade of injury, CT finding specifics such as contrast blush, complications, failure of NOM, time to angiography and techniques for embolization. Data were collected for 1004 pediatric patients treated for BLSI over the study period, 30 (3.0%) of which underwent angiography with or without embolization for BLSI. Ten of the patients who underwent angiography for BLSI failed NOM. For patients with embolized splenic injuries, splenic salvage was 100%. Four of the nine patients undergoing embolization of the liver ultimately required an operative intervention, but only one patient required hepatorrhaphy and no patient required hepatectomy after AE. Few angiography studies were obtained early during hospitalization for BLSI, with only one patient undergoing angiography within 1 hour of arrival at the PTC, and 7 within 3 hours. Angioembolization is rarely used in the management of BLSI in pediatric trauma patients with blunt abdominal trauma and is generally used in a delayed fashion. However, when implemented, angioembolization is associated with 100% splenic salvage for splenic injuries. Therapeutic/Care Management; Level IV.

Association of Contrast Extravasation Grade With Massive Transfusion in Pediatric Blunt Liver and Spleen Injuries: A Multicenter Retrospective Cohort Study

BackgroundThis study aimed to assess whether the grade of contrast extravasation (CE) on CT scans was associated with massive transfusion (MT) requirements in pediatric blunt liver and/or spleen injuries (BLSI). MethodsThis multicenter retrospective cohort study included pediatric patients (≤16 years old) who sustained BLSI between 2008 and 2019. MT was defined as transfusion of all blood products ≥40 mL/kg within the first 24 h of admission. Associations between CE and MT requirements were assessed using multivariate logistic regression analysis with cluster-adjusted robust standard errors to calculate the adjusted odds ratio (AOR). ResultsA total of 1407 children (median age: 9 years) from 83 institutions were included in the analysis. Overall, 199 patients (14 %) received MT. CT on admission revealed that 54 patients (3.8 %) had CE within the subcapsular hematoma, 100 patients (7.1 %) had intraparenchymal CE, and 86 patients (6.1 %) had CE into the peritoneal cavity among the overall cohort. Multivariate analysis, adjusted for age, sex, age-adjusted shock index, injury severity, and laboratory and imaging factors, showed that intraparenchymal CE and CE into the peritoneal cavity were significantly associated with the need for MT (AOR: 2.50; 95 % CI, 1.50–4.16 and AOR: 4.98; 95 % CI, 2.75–9.02, respectively both p < 0.001). The latter significant association persisted in the subgroup of patients with spleen and liver injuries. ConclusionActive CE into the free peritoneal cavity on admission CT was independently associated with a greater probability of receiving MT in pediatric BLSI. The CE grade may help clinicians plan blood transfusion strategies. Level of EvidenceLevel 4; Therapeutic/Care management.

Contrast-enhanced ultrasound (CEUS) in the follow-up of abdominal solid organ trauma: an international survey prior to the PseAn study.

The blunt and penetrating abdominal trauma follow-up relies on contrast CT scan to detect solid organ injuries. CEUS is not widely used worldwide, despite its accuracy and feasibility in identifying parenchymal and vascular lesions. This survey aims to define the current use of CEUS in Trauma Centers and the expectations of Emergency Surgeons regarding its role. We sent an online questionnaire composed of 10 questions to trauma physicians worldwide during the period of September 2022 to March 2023. 59 participants from 53 different centers answered the questionnaire. 76.2% of the enrolled participants have CEUS available at their Institution, and 49.2% think that it can replace CT scan. Contrast-CT scan remains the preferred option in the follow-up of blunt liver (69.5%), spleen (72.9%) and kidney (76.3%) injuries, followed by CEUS which is used in 18.6% for liver, 20.3% for spleen and 15.3% for kidney injuries. The results are similar for penetrating abdominal trauma, with contrast CT scan being the first-line imaging technique (91.5% for liver, 91.5% for spleen and 88.1% for kidney injuries), followed by CEUS (5.1% for liver, 5.1% for spleen and 6.8% for kidney injuries). Our survey shows that CEUS is still underutilized in the follow-up of abdominal trauma, even though many emergency surgeons consider it as a valid alternative to contrast CT scan.

Association of Time to Definitive Hemostasis With Mortality in Patients With Solid Organ Injuries.

Introduction The Golden Hour is a term used in the trauma setting to refer to the first 60 minutes after injury. Traditionally, definitive care within this period was believed to dramatically increase a patient's survival. Though the period of 60 minutes is unlikely to represent a point of distinct inflection in survival, the effect of time to definitive care on survival remains incompletely understood. This study aims to measure the association of time to definitive hemostasis with mortality in patients with solid organ injuries as well as the effect of survival bias and a form of selection bias known as indication by severity on the relationship between time to treatment and survival. Methodology This is a retrospective cohort study using data obtained from the American College of Surgeons National Trauma Data Bank (NTDB) from the years 2017 through 2019 selecting patients treated for blunt liver, spleen, or kidney injury who required angioembolization or surgical hemostasis within six hours. A Cox proportional hazards regression was used to analyze time to death. The association of probability of death with time was examined with a multivariate logistic regression initially treating the relationship as linear and subsequently transforming time to hemostasis with restricted cubic splines to model a non-linear association with the outcome. To model survival and indication by severity bias, we created a computer-generated data set and used LOESS regressions to display curves of the simulated data. Results The multivariate Cox proportional hazards analysis shows a coefficient of negative 0.004 for minutes to hemostasis with an adjusted hazard ratio of 0.9959 showing the adjusted hazard of death slightly diminishes with each increasing minute to hemostasis. The likelihood ratio chi-square difference between the model with time to hemostasis included as a linear term versus the model with the restricted cubic spline transformation is 97.46 (p<0.0001) showing the model with restricted cubic splines is a better fit for the data. The computer-generated data simulating treatment of solid organ injury with no programmed bias displays an almost linear association of mortality with increased treatment delay. When indications by severity bias and survival bias are introduced, the risk of death decreases with time to hemostasis as in the real-world data. Conclusion Decreasing mortality with increasing delay to hemostasis in trauma patients with solid organ injury is likely due to confounding due to indication by severity and survival bias. After taking these biases into account, the association of delayed hemostasis with better survival is not likely due to the benefit of delay but rather the delay sorts patients by severity of injury with those more likely to die being treated first. These biases are extremely difficult to eliminate which limits the ability to measure the true effect of delay with retrospective data. The findings may however be of value as a predictive model to anticipate the acuity of a patient after an interval of unavoidable delay such as with a long transfer time.

Role of Serial Phlebotomy in the Management of Blunt Solid Organ Injury in Adults.

The management of blunt spleen and liver trauma has become increasingly nonoperative. There is no consensus on timing or duration of serial hemoglobin and hematocrit monitoring in this patient population. This study examined the clinical utility of serial hemoglobin and hematocrit monitoring. We hypothesized that most interventions occur early in the hospital course, based on hemodynamic instability or physical examination findings rather than serial monitoring. We conducted a retrospective cohort study of adult trauma patients with blunt spleen or liver injury from November 2014 through June 2019 at our Level II trauma center. Interventions were classified as no intervention, surgical intervention, angioembolization, or packed red blood cell transfusion. Demographics, length of stay, total blood draws, laboratory values, and clinical triggers preceding intervention were reviewed. A total of 143 patients were studied, of whom 73 (51%) received no intervention, 47 (33%) received an intervention within 4 hr of presentation, and 23 (16%) had interventions beyond 4 hr. Of these 23 patients, 13 received an intervention based on phlebotomy results alone. Most of these patients (n = 12, 92%) received blood transfusion without further intervention. Only one patient underwent operative intervention based on serial hemoglobin results on hospital day 2. The majority of patients with these injury patterns either require no intervention or declare themselves promptly after arrival. Serial phlebotomy after initial triage and intervention may add little value in the management of blunt solid organ injury.

Invited Commentary on Williams, et al: Updated Guidelines for the Management of Blunt Liver and Spleen Injuries

Invited Commentary on Williams, et al: Updated Guidelines for the Management of Blunt Liver and Spleen Injuries

Institutional outcomes of blunt liver and splenic injury in the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium era.

The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium practice management guideline was created to standardize management of blunt liver or spleen injury across pediatric trauma centers. We describe our outcomes since guideline adoption at our institution and hypothesize that blunt liver or spleen injury may be managed more expeditiously than currently reported without compromising safety. A retrospective cohort study was conducted on patients younger than 18 years presenting with blunt liver and/or splenic injuries from March 2016 to March 2021 at one participating center. A total of 199 patients were included. There were no clinically relevant differences for age, body mass index, or sex among the cohort. Isolated splenic injuries (n = 91 [46%]) and motor vehicle collisions (n = 82 [41%]) were the most common injury and mechanism, respectively. The overall median length of stay (LOS) was 1.2 days (interquartile range, 0.45-3.3 days). Intensive care unit utilization was 23% (n = 46). There was no statistically significant difference in median LOS among patients with isolated solid organ injuries, regardless of injury grade. There were no readmissions associated with non-operative management. The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium guideline fosters high rates of nonoperative management with low intensive care unit utilization and LOS while demonstrating safety in implementation, irrespective of injury grade. Therapeutic/Care Management; Level IV.

In Solid Organ Injury Patients Requiring Blood Transfusion, Hemostatic Procedures are Associated with Improved Survival Over Observation.

Selective nonoperative management (NOM) is the standard of care for blunt solid organ injury (SOI). Hemodynamic instability is a contraindication for NOM, but it is unclear whether the need for blood transfusion should be a criterion for instability. This study looks at the outcome of blood-transfused SOI patients to determine whether NOM is safe for this group. This is a retrospective cohort study using the National Trauma Data Bank years 2017 through 2019. We selected patients with blunt liver, spleen, and kidney injuries. Within this group, we compared the mortality for those managed with NOM versus the hemostatic procedures of laparotomy and angioembolization. Significance for univariate analysis is tested with Chi-square for categorical variables. Multivariate analysis is performed with Cox proportional hazards regression with time-dependent covariate. 108,718 (3.5%) patients for the years 2017 through 2019 had a SOI. 20,569 (18.9%) of these received at least one unit of packed red blood cells (PRBCs) within the first 4 h. Of the SOI patients who received blood, 8264 (40.2%) underwent laparotomy only, 2924 (14.2%) underwent embolization only, and 1119 (5.4%) underwent both procedures. The adjusted odds ratios (ORs) of death for transfused SOI patients who underwent laparotomy only, embolization only, and both procedures are 0.93 (P = not significant), 0.27 (P < 0.001), and 0.48 (P < 0.001), respectively. The ORs of death with laparotomy for patients receiving >1 through 4 units are 0.87, 0.78, 0.75, and 0.72, respectively (P ≤ 0.01 for all). For embolization, the ORs are 0.27, 0.30, 0.30, and 0.30, respectively (P < 0.001 for all). Laparotomy is independently associated with survival for patients who receive >1 unit of PRBCs. Angioembolization is independently associated with survival for the entire cohort, including transfused patients. Given the protective association of laparotomy in the blood-transfused SOI group, need for blood transfusion should be considered a meaningful index of instability and a relative indication for laparotomy. The protective association with angioembolization supports current practices for angioembolization of high-risk patients in the transfused and nontransfused groups.

Therapeutic strategies for pseudoaneurysm following blunt liver and spleen injuries: A multicenter cohort study in the pediatric population.

Little guidance exists for the treatment of pseudoaneurysm (PA) following pediatric blunt liver and/or spleen injuries (BLSIs). We aimed to describe the incidence of delayed PA development and the subsequent clinical course of PA in pediatric BLSIs. This multicenter retrospective cohort study from Japan included pediatric patients (16 years and younger) who sustained BLSIs from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely, nonoperative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed PA among the groups and to characterize the clinical course of any PAs. A total of 1,407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed PA formation was 80 (5.7%), and the number with delayed PA rupture was 16 cases (1.1%) in the entire cohort. Patients treated with NOM (1,056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed PAs, respectively. Among patients who developed any PAs, 39% of patients underwent prophylactic IR for unruptured PA, while 13% required emergency angioembolization for delayed PA rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of PA without any interventions. Our results suggest that the risk of delayed PA still exists even after acute phase IR as an adjunct to NOM for BLSIs in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for PA management, including rupture cases, given the high incidence of spontaneous resolution, the ideal management of PA remains to be investigated in future studies. Therapeutic/Care Management; Level IV.

Retrospective Review of Risk Factors for Splenic Intervention in Adolescents with Blunt Spleen Injuries

Retrospective Review of Risk Factors for Splenic Intervention in Adolescents with Blunt Spleen Injuries

Non-operative management of solid organ injuries in a middle-income country, how does it stack up?

IntroductionThe first trauma surgery unit in Malaysia was established in 2011. After 10 years, we examine our experience in the management, and outcomes of blunt liver, spleen, and kidney injuries. MethodsThis is a cross-sectional study of patients with blunt liver, spleen, and kidney injuries in a level 1 trauma centre in Malaysia between January 2018 to June 2021. Patients’ characteristics, new injury severity score, organ-specific AAST injury score, type of primary management (operative management [OM], non-operative management [NOM]), causes of failed NOM, management of failed NOM, and outcome of treatment were recorded and analysed. ResultsAmong 448 patients, 83.9% were male and in the working-age range of 15–64 years old (93.5%). Road traffic crashes made up 92.0% of blunt trauma resulting in 65.5% of isolated organ injuries and 34.5% combined injuries. An overwhelming 84.2% of the patients had major trauma (NISS>15). Three hundred and thirty-four patients (74.6%) underwent initial non-operative management. Patients in the OM group showed lower mean GCS scores (p = 0.022) and higher NISS scores (p < 0.001). High-grade liver and kidney injuries were mostly treated with NOM (p < 0.001). In contradistinction, patients with high-grade spleen injuries had more OM performed (p < 0.001). NOM had been successful in 325 patients (97.3%) with 9 failures. Underlying causes for NOM failure were hemodynamic instability due to secondary bleeding and infectious complications. Overall mortality was 11.2%, which was significantly higher in the OM group (23.7%) than in the NOM group (6.9%). ConclusionThis study represents one of the largest single centre experiences on the blunt liver, spleen, and kidney injuries in Malaysia and South-East Asia. With good selection and adequate resources, non-operative management of blunt liver, spleen, and kidney injuries is a safe and effective therapeutic approach with a high success rate of 97.3%, avoiding the morbidity of unnecessary laparotomies.

Impact of the establishment of a trauma center on blunt traumatic spleen injury treatment: Comparison between pre-traumatic center and trauma center periods.

The spleen is a commonly injured intra-abdominal organ from blunt trauma. In cases of traumatic blunt spleen injury, immediate treatment is often required. This study aimed to investigate the prognostic impact of the establishment of a trauma center on the treatment of patients with blunt trauma injury to the spleen. We retrospectively reviewed 235 patients who visited our center from 2012 to 2019 for blunt trauma injury to the spleen. The study period was divided into two groups: January 2012 to September 2015 was the pre-center period (PCP), and September 2015 to December 2019 was the trauma center period (TCP). In each period, there were three treatment groups: Surgical group, embolization group, and conservative treatment group. The primary outcome was mortality, and the secondary outcomes were patient characteristics, such as injury severity score and abbreviated injury scale score, time from admission to intervention (both surgery and angiography embolization), and rate of spleen-preserving surgery. In the conservative treatment group, the Hb and hct values were relatively low in the TCP than in the PCP (p=0.007, p=0.008, respectively). The intensive care unit admission rate was relatively high in the TCP (72.9% vs. 90.6%, p=0.031). The ISS was relatively low in the TCP (18 vs. 17, p=0.001). In the surgical group, the time taken to transfer patients to the operating room after admission was greatly reduced in the TCP (151 min vs. 107 min, p=0.028). In the embolization group, the patient's age and SBP were lower in the PCP than in the TCP (p=0.003, p=0.049, respectively); three patients had undergone embolization with CPR in the PCP, and no patient underwent CPR in the TCP. There were three deaths in PCP and none in the TCP (p=0.05). The establishment of a trauma center has led to improvements in the treatment quality and prognosis of patients with blunt trauma injury to the spleen receiving either of the three treatments.

Retrospective review of intervention for traumatic blunt spleen injuries in adolescents by trauma center type

BackgroundManagement guidelines for pediatric blunt spleen injuries (BSI) include adolescent patients but few studies have compared current management of adolescents with respect to other age groups by center type. MethodsA retrospective review of 2017–2018 National Trauma Quality Improvement (TQIP) data of children (6–12), adolescents (13–17) and young adults (18–24) with BSI presenting to an adult, pediatric only, or adult/pediatric trauma center, comparing the rate of splenic intervention for adolescents by trauma center was performed. ResultsChildren had lower odds of spleen intervention than adolescents at both adult (OR 0.61 95%CI 0.39, 0.95) and adult/pediatric (OR 0.55 95%CI 0.35, 0.87) centers but did not differ at pediatric centers (OR 0.94 95%CI 0.39, 2.2) (n = 10,494). Adolescents adjusted odds of intervention was equal to adults at adult trauma centers (OR 1.2 95%CI 0.95, 1.4). ConclusionAdolescents are more likely to undergo interventions for BSI as compared to children at both adult and adult/pediatric trauma centers.

Novel tool (BIS) heralds the need for blood transfusion and/or failure of non-operative management in pediatric blunt liver and spleen injuries

BackgroundNon-operative management (NOM) is the standard of care for the majority of children with blunt liver and spleen injuries (BLSI). The shock index pediatric age-adjusted (SIPA) was previously shown to predict the need for blood transfusions in pediatric trauma patients with BLSI. We combined SIPA with base deficit (BD) and International Normalized Ratio (INR) to create the BIS score. We hypothesized that the BIS score would predict the need for blood transfusions and/or failure of NOM in pediatric trauma patients with BLSI. MethodsPatients (≤ 18 years) who presented to our Level I pediatric trauma center with BLSI from 2009 to 2019 were identified. BIS scores were calculated by giving 1 point for each of the following: base deficit ≤ -8.8, INR ≥ 1.5, or elevated SIPA. Receiver operating characteristic curves (ROC) were generated for BIS scores ≥ 1, ≥ 2, and ≥ 3. Area under the curve (AUC), sensitivity, and specificity of each score were calculated for ability to predict need for blood transfusions and/or failure of NOM. ResultsOf 477 children included, 19.9% required a blood transfusion and 6.7% failed NOM. A BIS score ≥ 1 was the best predictor of the need for blood transfusions with an AUC of 0.81 and a sensitivity of 96.0%. A BIS score ≥ 1 was also the best predictor of failure of NOM with an AUC of 0.72 and a sensitivity of 97.0%. ConclusionThe BIS score is a highly sensitive tool that identifies pediatric patients with BLSI at risk for blood transfusions and/or failure of NOM. Level of evidenceLevel III. Type of studyRetrospective comparative study.

Possibilities of non-operative and minimally invasive organ-preserving spleen injuries management in blunt abdominal injuries in adults

The Objective was to assess and improve the treatment results of victims with spleen injury in blunt abdominal trauma by using high-tech minimally invasive methods of diagnosis and treatment.Methods and materials. The article analyzed the results of treatment of 86 patients with isolated and combined blunt spleen injuries who received conventional surgery, and 52 similar patients who were treated in accordance with the new algorithm. This algorithm included conventional splenectomy for unstable hemodynamics and non-operative and minimally invasive management for stable hemodynamics after MSCT. In the absence of CT signs of ongoing bleeding, non-operative management was performed, if ongoing bleeding signs were detected, angiography with selective angioembolization was performed.Results. In both groups, most of the victims with blunt spleen injury were admitted to the trauma center after traffic accidents and catatraumas. There were no statistically significant differences in the injury severity (ISS, Tsibin scales), and the condition severity (VPH-SP). The tactics of non-operative and minimally invasive management was applied in 31 patients of the prospective group with stable hemodynamics. Non-operative management was performed on 16 patients of the prospective group. Four patients of this group underwent angiography and selective embolization of the branches of the splenic artery. In the retrospective group, there was a greater number of local complications compared to the prospective group (p=0.006). The decrease in the number of visceral and generalized complications was statistically insignificant (p&gt;0.05). In the retrospective group, 21 victims died. Of these, 12 patients died from severe combined trauma and massive blood loss during the first 24 hours. In the prospective group, the total number of deaths was 10 patients. Of these, 6 died from polytrauma with acute massive blood loss, 1 – from severe traumatic brain injury, 1 – from PE, 2 – from sepsis. In the prospective group, among the patients with stable hemodynamics who had conservative treatment of abdominal trauma, 2 deaths were observed in the long-term period due to severe traumatic brain injury and PE.Conclusion. Organ-preserving management was carried out in 26 of 52 (50 %) patients, the number of performed diagnostic laparocenteses was reduced by 50.6 %, laparoscopies – by 16.5 %, laparotomies – by 60.7 %, the duration of inpatient treatment of surviving patients was more than for 7 days, mortality – by 5.2 %.