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Critical Care
Published in: Critical Care 5/2013

Open Access 01-10-2013 | Research

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

Authors: Roberto Cirocchi, Carlo Boselli, Alessia Corsi, Eriberto Farinella, Chiara Listorti, Stefano Trastulli, Claudio Renzi, Jacopo Desiderio, Alberto Santoro, Lucio Cagini, Amilcare Parisi, Adriano Redler, Giuseppe Noya, Abe Fingerhut

Published in: Critical Care | Issue 5/2013

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Abstract

Introduction

The goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay.

Methods

For this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST.

Results

We identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison.

Conclusions

NOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.
Appendix
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Metadata
Title
Is non-operative management safe and effective for all splenic blunt trauma? A systematic review
Authors
Roberto Cirocchi
Carlo Boselli
Alessia Corsi
Eriberto Farinella
Chiara Listorti
Stefano Trastulli
Claudio Renzi
Jacopo Desiderio
Alberto Santoro
Lucio Cagini
Amilcare Parisi
Adriano Redler
Giuseppe Noya
Abe Fingerhut
Publication date
01-10-2013
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2013
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc12868

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