Spleen Trauma 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

Surgical Repair vs Splenectomy in Patients With Severe Traumatic Spleen Injuries

The spleen is often removed in laparotomy after traumatic abdominal injury, with little effort made to preserve the spleen. To explore the association of surgical management (splenic repair vs splenectomy) with outcomes in patients with traumatic splenic injuries undergoing laparotomy and to determine whether splenic repair is associated with lower mortality compared with splenectomy. This is a trauma registry-based cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2019. Participants included adult patients with severe splenic injuries (Abbreviated Injury Scale [AIS] grades 3-5) undergoing laparotomy after traumatic injury within 6 hours of admission. Data analysis was performed from April to August 2023. Splenic repair vs splenectomy in patients with severe traumatic splenic injury. The primary outcome was in-hospital mortality. Outcomes were compared using different statistical approaches, including 1:1 exact matching with consecutive conditional logistic regression analysis as the primary analysis and multivariable logistic regression, propensity score matching, and inverse-probability weighting as sensitivity analyses. A total of 11 247 patients (median [IQR] age, 35 [24-52] years; 8179 men [72.7%]) with a severe traumatic splenic injury undergoing laparotomy were identified. Of these, 10 820 patients (96.2%) underwent splenectomy, and 427 (3.8%) underwent splenic repair. Among patients who underwent an initial splenic salvage procedure, 23 (5.3%) required a splenectomy during the subsequent hospital stay; 400 patients with splenic preservation were matched with 400 patients who underwent splenectomy (matched for age, sex, hypotension, trauma mechanism, AIS spleen grade, and AIS groups [0-2, 3, and 4-5] for head, face, neck, thorax, spine, and lower and upper extremity). Mortality was significantly lower in the splenic repair group vs the splenectomy group (26 patients [6.5%] vs 51 patients [12.8%]). The association of splenic repair with lower mortality was subsequently verified by conditional regression analysis (adjusted odds ratio, 0.4; 95% CI, 0.2-0.9; P = .03). Multivariable logistic regression, propensity score matching, and inverse-probability weighting confirmed this association. In this retrospective cohort study, splenic repair was independently associated with lower mortality compared with splenectomy during laparotomy after traumatic splenic injury. These findings suggest that efforts to preserve the spleen might be indicated in selected cases of severe splenic injuries.

Rupture of an accessory spleen caused by blunt trauma.

The accessory spleen is quite a common abdominal anomaly. However, the traumatic accessory spleen rupture is an extremely rare condition requiring surgical intervention, even laparotomy. 9 cases of traumatic accessory spleen were found published between 1962 and 2022. The study aims to evaluate traumatic accessory spleen rupture cases regarding their causes, clinical course, and possible diagnosis without surgery and treatment. Desk research method using available online databases. Descriptive methods were employed to analyze the collected data. The results are summarized in the Table concerning gender, age, injury details, accessory spleen injury characteristics, treatment, and others such as previous splenectomy or primary spleen involvement in injury or accompanying abdominal injuries. In total, there were 9 cases of traumatic accessory spleen, of which 2 were managed conservatively and the remaining 7 were treated operatively. All the patients survived. One-third of all included patients already had their primary spleen removed, which facilitated the diagnosis of traumatic rupture of an accessory spleen. The proper diagnosis of an accessory spleen rupture was concluded in 2 cases and confirmed in surgery. The recognition of the traumatic rupture of an accessory spleen before surgery is challenging but can be made easier if the patient underwent splenectomy before. The traumatic accessory spleen rupture does not coexist with an injury of a primary spleen.

Spleen autotransplantation on liver versus greater omentum for simultaneous injuries of liver and spleen: an experimental study.

In a simulated situation of simultaneous spleen and liver trauma, we aimed to compare the outcomes of treating both injuries with spleen autotransplantation on the omentum (SAO) alongside hepatorrhaphy versus spleen autotransplantation as a patch on the liver parenchyma. A total of 24 rats were separated into two groups: the SAO and the spleen autotransplantation on the liver. They underwent a uniform and simultaneous procedure involving full-thickness injuries to the left lobe of the liver and grade 4 spleen injuries. We measured hemoglobin, white blood cell (WBC), complement (C3 and C4), and immunoglobulin G, M, and A (IgG, IgM, IgA) levels before and 4 weeks after the surgery. We utilized Technetium-99m scintigraphy to evaluate the posttransplant splenic graft functions 4 weeks after the surgery. The two groups had no significant difference in the hematologic and immunologic factors before surgery. However, both procedures significantly reduced hemoglobin, C3, IgG, and IgA levels (all P<0.05). WBC counts significantly increased in the SAO group, whereas the IgM level decreased after the intervention (P<0.05). WBC was increased in the SAO group, while IgM and IgA were decreased in the SAO group. The Technetium uptake was similar between the two groups (P=0.3). In simultaneous spleen and liver injuries, the autotransplantation of splenic into the liver parenchyma appears to be a promising surgical approach for preserving spleen function and hepatorrhaphy at the same time instead of doing them separately.

Abdominal peritoneal splenosis (clinical case)

Background. Splenosis, or heterotopic autotransplantation of spleen tissue, is a benign disease, occurring in patient after splenectomy. This formation demands correct differential diagnosis because it is often diagnosed as a tumor. Main methods of splenosis diagnosis are ultrasound inspection, CT, MRI, but detailed anamnesis is also important to set the correct diagnosis. The clinical case in this report is aimed to show importance of timely and correct diagnosis which will allow to avoid unnecessary invasive diagnostic procedures, late diagnosis and decreasing of medical assistance quality. Clinical case. patient 61 y. o. is suspected on a tumor in left iliac region. He noted the trauma after falling on a back. The inspection was performed: CT of iliac region showed formation in the small intestines. Splenectomy was carried out 20 years ago. The patient is set to the clinical medical center “Medicinsky gorod” to a surgeon-oncologist. physical examination and laboratory analysis showed no pathological changes. CT of abdominal organs showed formation with regular edges. MRI of pelvic organs with contrast agent showed formation accumulating contrast irregularly. Control CT of abdominal organs showed no increasing of formation size. Conclusion. Abdominal splenosis is a benign disease, occurring after spleen tissue implantation in the abdominal cavity after spleen trauma or splenectomy. Splenosis course is usually asymptomatic and it is often diagnoses as a peritoneal canceromatosis mistakenly. Splenosis has to be included in the differential diagnosis in patients with trauma or splenectomy in anamnesis.

Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy-An Ancillary Study.

The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive proximal splenic artery embolization (PPSAE). This ancillary study, using the SPLASH multicenter randomized prospective cohort, evaluated the feasibility, safety, and efficacy of PPSAE in patients with high-grade blunt splenic trauma without vascular anomaly on the initial CT scan. All patients included were over 18 years old, had high-grade splenic trauma (≥AAST-OIS 3 + hemoperitoneum) without vascular anomaly on the initial CT scan, received PPSAE, and had a CT scan at one month. Technical aspects, efficacy, and one-month splenic salvage were studied. Fifty-seven patients were reviewed. Technical efficacy was 94% with only four proximal embolization failures due to distal coil migration. Six patients (10.5%) underwent combined embolization (distal + proximal) due to active bleeding or focal arterial anomaly discovered during embolization. The mean procedure time was 56.5 min (SD = 38.1 min). Embolization was performed with an Amplatzer™ vascular plug in 28 patients (49.1%), a Penumbra occlusion device in 18 patients (31.6%), and microcoils in 11 patients (19.3%). There were two hematomas (3.5%) at the puncture site without clinical consequences. There were no rescue splenectomies. Two patients were re-embolized, one on Day 6 for an active leak and one on Day 30 for a secondary aneurysm. Primary clinical efficacy was, therefore, 96%. There were no splenic abscesses or pancreatic necroses. The splenic salvage rate on Day 30 was 94%, while only three patients (5.2%) had less than 50% vascularized splenic parenchyma. PPSAE is a rapid, efficient, and safe procedure that can prevent splenectomy in high-grade spleen trauma (AAST-OIS) ≥ 3 with high splenic salvage rates.

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.

Relationship Between Degree of Solid Organ Trauma to Intra-Abdominal Pressure (IAP) In Blunt Abdomen Trauma at Prof. Dr. I G.N.G. Ngoerah General Hospital, Bali, Indonesia

Background: Blunt abdominal trauma is a common trauma case with a high mortality rate. Increased Intra-Abdominal Pressure (IAP) is one of the factors that affect the morbidity and mortality rates of blunt abdominal trauma. In this condition the authors are interested in examining the relationship between the Degree of Solid Organ Trauma and Intra-Abdominal Pressure (IAP) in Blunt Abdominal Trauma. Objective: To determine the relationship between the degree of hepatic, spleen and multi-organ trauma to intra-abdominal pressure (IAP) in patients with blunt abdominal trauma. Methods: This study used a prospective observational design, with an analytic cross-sectional design to assess the relationship between the degree of solid organ trauma and intra-abdominal pressure (IAP) in blunt abdominal trauma involving 45 samples of patients with blunt abdominal trauma at Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital in the period November 2021 – November 2022. Results: Intra-abdominal pressure (IAP) was significantly correlated with the degree of spleen trauma with an r value of 0.403 (p: 0.046) which indicated that intra-abdominal pressure (IAP) increased with increasing degree of splenic trauma. Conclusion: Splenic trauma is associated and significantly correlated with increased intra-abdominal pressure (IAP) and its degree in blunt abdominal trauma patients.

Clinical outcomes of splenic arterial embolization for blunt splenic injury in pediatric and adolescent patients.

Splenic arterial embolization (SAE) is an effective intervention for the management of arterial hemorrhage asso-ciated with blunt splenic injury. However, its role and clinical outcomes in pediatric and adolescent patients are unclear. The aim of this study is to assess the role and the clinical outcomes of SAE for blunt splenic injuries in pediatric and adolescent trauma patients. A retrospective cohort study was performed in patients aged ≤17 years with blunt splenic injury transferred to a re-gional trauma center in a tertiary referral hospital between November 01, 2015, and September 30, 2020. The final study population consisted of 40 pediatric and adolescent patients with blunt splenic injuries. The patient demographics, mechanisms of injury, details of injuries, angiographic findings, embolization techniques, and technical and clinical outcomes, including spleen salvage rates and pro-cedure-related complications, were examined. Of the 40 pediatric and adolescent patients with blunt splenic injury, 17 underwent SAE (42.53%). The clinical success rate was 88.2% (15/17). No cases of embolization-related complications or clinical failure were observed. Spleen salvage after SAE was achieved in all patients. In addition, no statistically significant differences were observed in clinical outcomes (clinical success and spleen salvage rates) between low-grade (World Society of Emergency Surgery [WSES] spleen trauma classification I or II) and high-grade (WSES classification III or IV) splenic injury groups. SAE is a safe and feasible procedure, and is effective for successful spleen salvage of blunt splenic injuries in pediatric and adolescent patients.

Changes to the myocardial enzyme spectrum in patients with different degrees of spleen injury and their clinical value.

To investigate the changes to the myocardial enzyme profile and its clinical value in patients with different degrees of spleen injury. Of all patients who underwent total splenectomy due to trauma-induced spleen injury from January 2019 to January 2022 were selected, 70 patients with grade III and IV spleen injuries were selected as the experimental group. In addition, 70 patients with grade I and II were selected as control group 1, and another 70 patients as control group 2. The levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) in the 3 groups were detected before (T0) and on the 1st day (T1) after surgery, on the 3rd day (T2) and on the 7th day (T3) after surgery, and on the 14th day (T4) after surgery, respectively, to analyze the relationship with the severity of spleen injury. The spleen injury experimental group, control group 1, and control group 2 were all cured and discharged after corresponding treatment, and there was no myocardial infarction within 3 months of hospitalization and discharge follow-up. The experimental group had higher CK, CK-MB, and LDH than control group 1 and control group 2 at the same time point from T0 to T4 (P<.05); the CK and CK-MB of control group 1 were higher than those of control group 2 at the same time points from T0 to T4 (P < .05), the LDH at points T0 to T2 was higher than that of control group 2 (P < .05), and the LDH was lower at points T3 and T4. Compared with T0 in the same group, CK, CK-MB, and LDH at T1 to T4 in the 3 groups were all lower than those at T0 (P < .05). The early peripheral blood myocardial enzyme spectrum of patients with different degrees of spleen injury is increased, and the increase of myocardial enzyme spectrum is positively correlated with the severity of spleen injury, suggesting that patients with traumatic spleen injury may have myocardial damage in the early stage, and should be treated as soon as possible.

Development and validation of the diagnostic accuracy of artificial intelligence-assisted ultrasound in the classification of splenic trauma.

Spleen is the most vulnerable organ in abdominal trauma. Ultrasound (US) has become an important examination method for splenic trauma. However, the sensitivity of routine US in the diagnosis of splenic trauma is low. Contrast-enhanced ultrasound (CEUS) can improve the sensitivity, but it also has some limitations. This study sought to explore the application value of artificial intelligence (AI)-assisted US in the classification of splenic trauma. The splenic injuries of Bama miniature pigs were established. A large number of ultrasonic images were collected. Then, 3-fold cross validation (CV) was used to establish the animal models. Next, clinical ultrasonic images were collected at multiple centers. All injuries were diagnosed by CEUS, enhanced CT or surgery. We used animal models to fine tune a small amount of human data, and then established the final AI splenic trauma recognition model. The whole model was constructed by averaging the prediction ability of the 3 fine-tuned models. Finally, 2 doctors' recognition US results of splenic trauma were compared to the AI recognition results. The area under the curve (AUC), sensitivity, specificity, negative predictive value, and positive predictive value were used to evaluate the diagnostic performance in diagnosis of spleen trauma. (I) Based on the receiver operating characteristic (ROC) curves, the test cohort 1 (AUC =0.90) and 2 (AUC =0.84) had a similar performance. Based on the decision curve analysis (DCA) curves, while threshold smaller than 0.8, the proposed model had better performance on test cohort 1 than test cohort 2. Test cohort 1 had higher sensitivity (0.82 vs. 0.71, P<0.01) and higher specificity (0.88 vs. 0.81, P<0.01) than test cohort 2. (II) The diagnostic accuracy of the AI model was higher than that of doctor 1 (0.82 vs. 0.62, P<0.001) and doctor 2 (0.82 vs. 0.66, P<0.001), and its specificity was higher than that of doctor (0.88 vs. 0.78, P=0.001). AI-assisted US diagnosis of splenic trauma can significantly improve the ultrasonic diagnosis rate. We still need to increase the number of samples to further improve the diagnostic efficiency of the model.

Importance of the neutrophil‑to‑lymphocyte ratio as a prognostic factor in patients with spleen trauma: A single center experience.

Abdominal trauma is a common diagnosis for patients admitted to the emergency room. Evaluation of the severity of such patients can sometimes be difficult due to rapid hemodynamic changes caused by the activation of inflammatory and anti-inflammatory regulatory mechanisms. To evaluate the prognosis of trauma patients, it is crucial to identify these changes and adapt various treatment strategies. Using the records of the Mures County Emergency Clinical Hospital, 126 patients were included in the present study with traumatic splenic injury admitted over 6 years. Blood parameters such as the neutrophil, lymphocyte, and platelet counts, the neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio (PLR) were determined, and the association between these and the severity of the traumatic injury [quantified as the injury severity score (ISS)] was calculated. We used linear and multiple regression analyses to identify and quantify the relationships. We found statistically significant associations between the ISS and the NLR (P=0.002), with an AUC of 0.816 and a cut-off value of NLR=6.075 (sensitivity=76.7%, specificity=74.3%), and between the ISS and hemoglobin (P<0.0001), hematocrit (P<0.0001), neutrophil count (P<0.0001), lymphocyte count (P=0.0224), and platelet count (P=0.0163). No association was found between the PLR and the severity of trauma. An elevated NLR at admission in trauma patients had significant predictive power for the severity of trauma. Patients with an NLR greater than the cut-off value of 6.075 were more likely to have suffered serious injuries and undergone deterioration.

SP5.1.3 Early initiation of chemical venous thromboembolism (VTE) prophylaxis following traumatic spleen injury is safe and effectively reduce VTE events

Abstract Aims Within the first 48 hours (h) of trauma, hyper-coagulation state occurs which put trauma patients at risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE), leading to an increase rate of mortality. Non operative management (NOM) is now the standard of care for traumatic splenic injuries (TSI). However, timing of initiating chemical venous thromboembolism (VTE) prophylaxis, heparin or low molecular weight heparin (LMWH), remains controversial due to concern of rebleeding. This study examines the safety and timing of initiating VTE prophylaxis post TSI. Methods Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015–2020 in a single tertiary trauma centre. Clinical and radiological information were collected retrospectively. TSI were graded using AAST classification. VTE prophylaxis initiation were categorised as not given, &amp;lt;48h and &amp;gt;48h following the injury. Results In total 102 patients were included. Fifty-three percent (54/102) had Grade 3 injury and above. Majority 90/102 (88%) of patients were treated non-operatively. VTE prophylaxis was not given for 31 (30.4%), initiated for 37 (36.3%) within 48h and given to 34 (33.3%) patients after 48h. Seven (7%) patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48h. None of the patients who received VTE prophylaxis had rebleeding. Conclusions This study showed that early initiation of chemical VTE prophylaxis (&amp;lt;48h) is safe, resulted in lower incidence of DVTs/PEs without increase risk of bleeding. Results from this study supports recommendation from other studies to initiate chemical VTE prophylaxis after TSI as early as 24h post injury.

Cirugía conservadora del bazo. Fundamentos y opciones técnicas

Review of the literature regarding spleen surgery shows us that total splenectomy, regardless of the degree of splenic injury, has been established over the centuries in the treatment of choice, not only because of the lack of more conservative methods because it was not possible to identify some important function of the spleen. Although the spleen is not essential for life, its removal can cause lower resistance to systemic infections, and easier diffusion by hematic route of bacteria although their functions can be assumed by other lymphoid organs and bone marrow. Recognition of immune functions and the segmental structure of the spleen have been that have laid the bases of conservative surgery in spleen trauma, and the increased risk of infection has gone, in particular the post-splenectomy sepsis, who has promoted the design and application of different methods and operative techniques to avoid the total splenectomy, since the conservation of a portion of organ could be enough to prevent such a fearsone complication. In this article the fundamentals and technical options of conservative surgery in spleen trauma are exposed.

Atraumatic splenic rupture in a patient after apixaban use and radiologically inserted gastrostomy – a case report

Andrius Račiūnas1 1Royal London Hospital, Barts Health NHS Trust, Ear, Nose & Throat Department, London, United Kingdom Abstract: Introduction. Atraumatic splenic rupture (ASR), also known as spontaneous splenic rupture, is a rare, potentially life-threatening condition that can be a result of infection, malignancy, inflammation, and a complication of various surgical procedures. There are not enough studies about patient characteristics, incidence rates, aetiology, and guidelines for management associated with ASR. Clinical case. A 53-year-old gentleman had a transoral robotic resection of the left tongue base/aryepiglottic fold carcinoma and level 2-4 neck dissection. Subsequently, he had a radiologically inserted gastrostomy (RIG) for his dysphagia and airway protection. Two days after RIG was inserted, the patient collapsed in the ward. Blood tests were done and showed a severe haemoglobin level drop from 123 g/L to 73 g/L. Computer Tomography (CT) of the abdomen showed splenic bleeding. He had emergency laparotomy with splenectomy which showed no signs of traumatic spleen rupture secondary to RIG insertion. A histopathology sample taken in theatre showed no pathological changes in the spleen. There were no other causes apart from apixaban which was stopped before the procedure and resumed 24 hours after RIG insertion. Conclusion. ASR is a rare event in healthcare and the symptoms are not specific. Abdominal pain on the left side that can spread to the shoulder, a decrease in haemoglobin level, and signs of haemorrhagic shock are all possible signs of bleeding in the spleen. Anticoagulant therapies such as apixaban, rivaroxaban, direct-acting oral anticoagulants (DOAC), and dabigatran are linked to instances of ASR. Keywords. Atraumatic splenic rupture, splenectomy, radiologically inserted gastrostomy, apixaban.

The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres

PurposeTo compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.MethodsUK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.ResultsAll 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic.ConclusionsUK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.

335 Early Initiation of Biochemical Venous Thromboembolism Prophylaxis Following Traumatic Spleen Injury Is Safe and Effectively Reduce VTE Events.

Abstract Aim This study examines the safety and timing initiating VTE prophylaxis post traumatic splenic injuries (TSI). Method Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015–2020 in a single tertiary trauma centre. Clinical and radio-logical information were collected retrospectively. TSI were graded using American Association for the Surgery of Trauma (AAST) splenic injury scale. Chemical venous thromboprophylaxis initiation were categorised as not given, &amp;lt;48h and &amp;gt;48h following the injury. Results In total 102 patient were included out of 136 patients identified with TSI. 34 patients were excluded for lack of electronic data, palliative decision, or fatal condition on arrival. 12 patients out of 102 required operative management (OM) and 90 patients NOM. VTE prophylaxis was not given for 31 (30.4%). Medical reasons for this include severe brain injury and early discharge before 48 hours. VTE prophylaxis was initiated for 37 (36.3%) patients within 48 hours, and for 34 patients (33.3%) after 48 hours of admission. Seven patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48 hours. Importantly, none of the patients who received VTE prophylaxis had rebleeding. Conclusions This study showed that early initiation of chemical VTE prophylaxis (&amp;lt;48h) is safe, resulted in lower incidence of DVTs/PEs without increasing the risk of bleeding. Results from this study supports recommendation from other studies 1 to initiate chemical VTE prophylaxis after TSI as early as 24h post injury with no other contra-indications.

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.

Changes in the filtration function of the spleen after surgery following traumatic organ injuries

The incidence of splenic injuries among all closed injuries of the abdominal cavity is from 15.5 to 30.0 %, and a mortality rate is between 7 % and 26 %. The tactics in the treatment of splenic injuries is determined by the degree of traumatic injury, the patient's condition during the operation, and a concomitant pathology. Studies of tissue regeneration of the operated spleen allow identifying two main options for its regeneration, associated with the nature of blood circulation in the preserved part. Objective — to study the regeneration and filtration function of the spleen after various types of surgery for the management of traumatic spleen injuries. Materials and methods. The results of treatment of 85 patients in the period 2015 — 2020 were analyzed. To investigate the changes in the filtration function of the spleen, a study of the peripheral blood (general blood test) was performed to assess the shape of erythrocytes. In order to determine the size of the residual splenic parenchyma, its structure and regenerative processes were evaluated and sonographic examination was carried out. Results. The average increase in the size of the residual splenic tissue after subtotal resection of the organ with the formation of couplings of the parenchyma averages 40.2 ± 3.4 % one year after surgery, and in patients who underwent subtotal resection of the spleen with covering the cut plane with adhesive hemostatic plate 70 % — 49.14 ± 6.77 %. The study of changes in the filtration function of the spleen in patients, who underwent subtotal resection of the spleen, showed the appearance of target cells, acanthocytes and halocytes in the peripheral blood, but their number was insignificant and did not exceed normal (not more than 3 %). Any destroyed and pathologically altered erythrocytes were not visualized in patients, who underwent atypical resection of the spleen (mass deficit less than 30 %). Conclusions. Spleen regeneration is determined both by the nature of blood supply to the residual splenic tissue and its size, and does not depend on the nature of the pathological process. Organ‑preserving surgical interventions on the spleen allow maintaining the filtration function of the spleen.

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.