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01-05-2020 | Laparotomy | Surgery in Low and Middle Income Countries

Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa

Authors: Matthew C. Hernandez, Michael D. Traynor, Ariel W. Knight, Victor Y. Kong, Grant L. Laing, John L. Bruce, Wanda Bekker, Martin D. Zielinski, Damian L. Clarke

Published in: World Journal of Surgery | Issue 5/2020

Abstract

Introduction

We aimed to expand on the global surgical discussion around splenic trauma in order to understand locally and clinically relevant factors for operative (OP) and non-operative management (NOM) of splenic trauma in a South African setting.

Methods

A retrospective cohort study was performed using 2013–2017 data from the Pietermaritzburg Metropolitan Trauma Service. All adult patients (≥15 years) were included. Those managed with OP or NOM for splenic trauma were identified and analyzed descriptively. Multiple logistic regression analysis identified patients and clinical factors associated with management type.

Results

There were 127 patients with splenic injury. Median age was 29 [19–35] years with 42 (33%) women and 85 (67%) men. Blunt injuries occurred in the majority (81, 64%). Organ Injury Scale (OIS) grades included I (25, 20%), II (43, 34%), III (36, 28%), IV (15, 11%), and V (8, 6%). Nine patients expired. On univariate analysis, increasing OIS was associated with OP management, need for intensive care unit (ICU) admission, and hospital and ICU duration of stay, but not mortality. In patients with a delayed compared to early presentation, ICU utilization (62% vs. 36%, p = 0.008) and mortality (14% vs. 4%, p = 0.03) were increased. After adjusting for age, sex, presence of shock, and splenic OIS, penetrating trauma (adjusted odds ratio, 5.7; 95%CI, 1.7–9.8) and admission lactate concentration (adjusted odds ratio, 1.4; 95%CI 1.1–1.9) were significantly associated with OP compared to NOM (p = 0.002; area under the curve 0.81).

Conclusions

We have identified injury mechanism and admission lactate as factors predictive of OP in South African patients with splenic trauma. Timely presentation to definitive care affects both ICU duration of stay and mortality outcomes. Future global surgical efforts may focus on expanding non-operative management protocols and improving pre-hospital care in patients with splenic trauma.

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Title: Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa
Authors: Matthew C. Hernandez
Michael D. Traynor
Ariel W. Knight
Victor Y. Kong
Grant L. Laing
John L. Bruce
Wanda Bekker
Martin D. Zielinski
Damian L. Clarke
Publication date: 01-05-2020
Publisher: Springer International Publishing
Keywords: Laparotomy
Splenectomy
Splenectomy
Laparotomy
Published in: World Journal of Surgery / Issue 5/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05370-z

At a glance: The STEP trials

Springer Medicine

Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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