Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2018

01-06-2018 | Original Article

Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study

Authors: Stella R. Smith, Louise Morris, Stephen Spreadborough, Waleed Al-Obaydi, Marta D’Auria, Hilary White, Adam J. Brooks

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2018

Login to get access

Abstract

Purpose

To review the management of patients >16 years with blunt splenic injury in a single, UK, major trauma centre and identify whether the following are associated with success or failure of non-operative management with selective use of arterial embolization (NOM ± AE): age, Injury Severity Score (ISS), head injury, haemodynamic instability, massive transfusion, radiological hard signs [contrast extravasation or pseudoaneurysm on the initial computed tomography (CT) scan], grade, and presence of intraparenchymal haematoma or splenic laceration.

Methods

Retrospective, cross-sectional study undertaken between April 2012 and October 2015. Paediatric patients, penetrating splenic trauma, and iatrogenic injuries were excluded. Follow-up was for at least 30 days.

Results

154 patients were included. Median age was 38 years, 77.3% were male, and median ISS was 22. 14/87 (16.1%) patients re-bled following NOM in a median of 2.3 days (IQR 0.8–3.6 days). 8/28 (28.6%) patients re-bled following AE in a median of 2.0 days (IQR 1.3–3.7 days). Grade III–V injuries are a significant predictor of the failure of NOM ± AE (OR 15.6, 95% CI 3.1–78.9, p = 0.001). No grade I injuries and only 3.3% grade II injuries re-bled following NOM ± AE. Age ≥55 years, ISS, radiological hard signs, and haemodynamic instability are not significant predictors of the failure of NOM ± AE, but an intraparenchymal or subcapsular haematoma increases the likelihood of failure 11-fold (OR 10.9, 95% CI 2.2–55.1, p = 0.004).

Conclusions

Higher grade injuries (III–V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM ± AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24 h with appropriate advice.
Literature
1.
Costa GI, Tierno SM, Tomassini F, Venturini L, Frezza B, et al. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir. 2010;81(2):95–102.PubMed
2.
Moore EE, Cogbill TH, Malangoni M, Jurkovich GJ, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38(3):323–4.CrossRefPubMed
3.
Shapiro MJ, Krausz C, Durham RM, Mazuski J, Battistella FD, et al. Overuse of splenic scoring and computed tomographic scans. J Trauma. 1999;47:651–8.CrossRefPubMed
4.
Scarborough JE, Ingraham AM, Liepert AE, Jung HS, O’Rourke AP, et al. Non-operative management is as effective as immediate splenectomy for adult patients with high-grade blunt splenic injury. J Am Coll Surg. 2016;223(2):249–58.CrossRefPubMed
5.
Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, et al. Management of the most severely injured spleen: a multicenter study of the research consortium of new england centers for trauma (ReCONECT). Arch Surg. 2010;145(5):456–60.CrossRefPubMed
6.
McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg. 2005;140:563–9.CrossRefPubMed
7.
Requarth JA, D’Agostino RB, Miller PR. Nonoperative management of adult blunt splenic injury with and without splenic artery embolotherapy: a meta-analysis. J Trauma. 2011;71(4):898–903.CrossRefPubMed
8.
Haan JM, Bochicchio GV, Kramer N, Scalea TM. Non-operative management of blunt splenic injury: a 5 year experience. J Trauma. 2005;58:492–8.CrossRefPubMed
9.
Konstantakos AK, Barnoski AL, Plaisier BR, Yowler CJ, Fallon WF Jr, et al. Optimizing the management of blunt splenic injury in adults and children. Surgery. 1999;126:805–12.CrossRefPubMed
10.
Fu CY, Wu SC, Chen RJ, Chen YF, Wang YC, et al. Evaluation of need for operative intervention in blunt splenic injury: intraperitoneal contrast extravasation has an increased probability of requiring operative intervention. World J Surg. 2010;34(11):2745–51.CrossRefPubMed
11.
Zarzaur BL, Kozar R, Myers JG, Claridge JA, Scalea TM, et al. The splenic injury outcomes trial: an american association for the surgery of trauma multi-institutional study. J Trauma Acute Care Surg. 2015;79(3):335–42.CrossRefPubMed
12.
Lopez JM Jr, McGonagill PW, Gross JL, Hoth JJ, Chang MC, et al. Subcapsular hematoma in blunt splenic injury: a significant predictor of failure of nonoperative management. J Trauma Acute Care Surg. 2015;79(6):957–60.CrossRefPubMed
13.
Olthof DC, Joosse P, van der Vlies CH, de Haan RJ, Goslings JC. Prognostic factors for the failure of non-operative management in adults with blunt splenic injury. J Trauma. 2013;74(2):546–57.CrossRef
14.
Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, et al. Selective nonoperative management of blunt splenic injury: an eastern association for the surgery of trauma practice management guideline. J Trauma. 2012;73(5):S294–300.CrossRef
15.
Lecky Fiona. Twenty-five years of the trauma audit and research network: a continuing evolution to drive improvement. Emerg Med J. 2015;32:906–8.CrossRefPubMed
16.
17.
18.
Yiannoullou P, Hall C, Newton K, Pearce L, Bouamra O, et al. A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes? Ann R Coll Surg Engl. 2017;99:63–9.CrossRefPubMedPubMedCentral
19.
Moore FA, Davis JW, Moore EE, Cocanour CS, West MA, et al. Western trauma association (WTA) critical decisions in trauma: management of adult blunt splenic injury. J Trauma. 2008;65:1007–11.CrossRefPubMed
20.
Tugnoli G, Bianchi E, Biscardi A, Coniglio C, Isceri S, et al. Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. The results of the Bologna-Maggiore hospital trauma center experience and development of a clinical algorithm. Surg Today. 2015;45(10):1210–7.CrossRefPubMed
21.
Bhullar I, Frykberg ER, Tepas JJ III, Siragusa D, Loper T, et al. At first blush: absence of computed tomography contrast extravasation in Grade IV or V adult blunt splenic trauma should not preclude angioembolization. J Trauma Acute Care Surg. 2013;74(1):105–12.CrossRefPubMed
22.
Banerjee A, Duane TM, Wilson SP, Haney S, O’Neill PJ, et al. Trauma center variation in splenic artery embolization and spleen salvage: a multicenter analysis. EAST plenary paper. J Trauma Acute Care Surg. 2013;75(1):69–75.CrossRefPubMed
23.
Sabe AA, Claridge JA, Rosenblum DI, Lie K, Malangoni MA. The effects of splenic artery embolization on nonoperative management of blunt splenic injury: a 16-year experience. J Trauma. 2009;67(3):565–72.CrossRefPubMed
24.
Falimirski ME, Provost D. Nonsurgical management of solid abdominal organ injury in patients over 55 years of age. Am Surg. 2000;66(7):631–5.PubMed
25.
Sharma OP, Oswanski MF, Singer D, Raj SS, Daoud YA. Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg. 2005;71(5):379–86.PubMed
26.
Alabbasi T, Nathens AB, Tien H. Blunt splenic injury and severe brain injury: a decision analysis and implications for care. J can chir. 2015;58(3):S108–17.
27.
Watson GA, Rosengart MR, Zenati MS, Tsung A, Forsythe RM, et al. Nonoperative management of severe blunt splenic injury: are we getting better? J Trauma. 2006;61(5):1113–8.CrossRefPubMed
28.
Peitzman A, Heil B, Rivera L, Federle MB, Harbrecht BG, et al. Blunt splenic injury in adults: multi-institutional study of the eastern association for the surgery of trauma. J Trauma. 2000;49(2):177–87.CrossRefPubMed
29.
Smith J, Armen S, Cook CH, Martin LC. Blunt splenic injuries: have we watched long enough? J Trauma. 2008;64(3):656–63.CrossRefPubMed
30.
Velmahos GC, Chan LS, Kamel E, Murray JA, Yassa N, et al. Non-operative management of splenic injuries—have we gone too far? Arch Surg. 2000;135:674–9.CrossRefPubMed
31.
Sartorelli KH, Frumiento C, Rogers FB, Osler TM. Nonoperative management of hepatic, splenic, and renal injuries in adults with multiple injuries. J Trauma. 2000;49(1):56–61.CrossRefPubMed
32.
London JA, Parry L, Galante J, Battistella F. Safety of early mobilization of patients with blunt solid organ injuries. Arch Surg. 2008;143(10):972–6.CrossRefPubMed
33.
Duchesne JC, Simmons JD, Schmieg RE Jr, McSwain NE Jr, Bellows CF. Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis. J Trauma. 2008;65(6):1346–51.CrossRefPubMed
34.
Peitzman AB, Harbrecht BG, Rivera L, Heil B. Eastern association for the surgery of trauma multiinstitutional trials workgroup. Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg. 2005;201:179–87.CrossRefPubMed
35.
Zarzaur BL, Vashi S, Magnotti LJ, Croce MA, Fabian TC. The real risk of splenectomy after discharge home following nonoperative management of blunt splenic injury. J Trauma. 2009;66(6):1531–6.CrossRefPubMed
36.
Fata P, Robinson L, Fakhry SM. A survey of EAST member practices in blunt splenic injury: a description of current trends and opportunities for improvement. J Trauma. 2005;59(4):836–41.CrossRefPubMed
37.
Alarhayem AQ, Myers JG, Dent D, Lamus D, Lopera J, et al. Blush at first sight: significance of computed tomographic and angiographic discrepancy in patients with blunt abdominal trauma. Am J Surg. 2015;210(6):1104–10.CrossRefPubMed
Metadata
Title
Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study
Authors
Stella R. Smith
Louise Morris
Stephen Spreadborough
Waleed Al-Obaydi
Marta D’Auria
Hilary White
Adam J. Brooks
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-017-0807-5

Other articles of this Issue 3/2018

European Journal of Trauma and Emergency Surgery 3/2018 Go to the issue

Review Article

Macrophages play an essential role in trauma-induced sterile inflammation and tissue repair

Original Article

The anatomical relationship of the neurovascular structures in direct posterior lateral gastrocnemius split approach for posterolateral tibial plateau fractures

Original Article

Intramedullary tibial nailing of distal tibiofibular fractures: additional fibular fixation or not?

Review Article

Danger signals in trauma

Original Article

Failure to rescue the elderly: a superior quality metric for trauma centers

Letter to the Editor

Reply to the letter to the editor “Minimized approaches to the posterolateral chest wall in the fixation of rib fracture” by Yih-Wen Tarng, Yi-Pin Chou, Tung-Ho Wu, Hsing-Lin Lin