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Published in: European Journal of Trauma and Emergency Surgery 2/2020

01-04-2020 | Original Article

The need for red blood cell transfusions in the emergency department as a risk factor for failure of non-operative management of splenic trauma: a multicenter prospective study

Authors: Paola Fugazzola, Lucia Morganti, Federico Coccolini, Stefano Magnone, Giulia Montori, Marco Ceresoli, Matteo Tomasoni, Dario Piazzalunga, Stefano Maccatrozzo, Niccolò Allievi, Savino Occhionorelli, Luca Ansaloni

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2020

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Abstract

Introduction

The majority of patients with splenic trauma undergo non-operative management (NOM); around 15% of these cases fail NOM and require surgery. The aim of the current study is to assess whether the hemodynamic status of the patient represents a risk factor for failure of NOM (fNOM) and if this may be considered a relevant factor in the decision-making process, especially in Centers where AE (angioembolization), intensive monitoring and 24-h-operating room are not available. Furthermore, the presence of additional risk factors for fNOM was investigated.

Materials and methods

This is a multicentre prospective observational study, including patients presenting with blunt splenic trauma older than 17 years, managed between 2014 and 2016 in two Italian trauma centres (ASST Papa Giovanni XXIII in Bergamo and Sant’Anna University Hospital in Ferrara—Italy). The risk factors for fNOM were analyzed with univariate and multivariate analyses.

Results

In total, 124 patients were included in the study. In univariate analysis, the risk factors for fNOM were AAST grade > 3 (fNOM 37.5% vs 9.1%, p = 0.024), and the need of red blood cell (RBC) transfusion in the emergency department (ED) (fNOM 42.9% vs 8.9%, p = 0.011). Multivariate analysis showed that the only significant risk factor for fNOM was the need for RBC transfusion in the ED (p = 0.049).

Conclusions

The current study confirms the contraindication to NOM in case of hemodynamically instability in case of splenic trauma, as indicated by the most recent guidelines; attention should be paid to patients with transient hemodynamic stability, including patients who require transfusion of RBC in the ED. These patients could benefit from AE; in centers where AE, intensive monitoring and an 24-h-operating room are not available, this particular subgroup of patients should probably be treated with operative management.
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Metadata
Title
The need for red blood cell transfusions in the emergency department as a risk factor for failure of non-operative management of splenic trauma: a multicenter prospective study
Authors
Paola Fugazzola
Lucia Morganti
Federico Coccolini
Stefano Magnone
Giulia Montori
Marco Ceresoli
Matteo Tomasoni
Dario Piazzalunga
Stefano Maccatrozzo
Niccolò Allievi
Savino Occhionorelli
Luca Ansaloni
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 2/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-1032-6

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