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Patient Safety in Surgery
Published in: Patient Safety in Surgery 1/2018

Open Access 01-12-2018 | Research

Safety of selective nonoperative management for blunt splenic trauma: the impact of concomitant injuries

Authors: Michel Paul Johan Teuben, Roy Spijkerman, Taco Johan Blokhuis, Roman Pfeifer, Henrik Teuber, Hans-Christoph Pape, Luke Petrus Hendrikus Leenen

Published in: Patient Safety in Surgery | Issue 1/2018

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Abstract

Background

Nonoperative management for blunt splenic injury is the preferred treatment. To improve the outcome of selective nonoperative therapy, the current challenge is to identify factors that predict failure. Little is known about the impact of concomitant injury on outcome. Our study has two goals. First, to determine whether concomitant injury affects the safety of selective nonoperative treatment. Secondly we aimed to identify factors that can predict failure.

Methods

From our prospective trauma registry we selected all nonoperatively treated adult patients with blunt splenic trauma admitted between 01.01.2000 and 12.21.2013. All concurrent injuries with an AIS ≥ 2 were scored. We grouped and compared patients sustaining solitary splenic injuries and patients with concomitant injuries. To identify specific factors that predict failure we used a multivariable regression analysis.

Results

A total of 79 patients were included. Failure of nonoperative therapy (n = 11) and complications only occurred in patients sustaining concomitant injury. Furthermore, ICU-stay as well as hospitalization time were significantly prolonged in the presence of associated injury (4 versus 13 days,p < 0.05). Mortality was not seen. Multivariable analysis revealed the presence of a femur fracture and higher age as predictors of failure.

Conclusions

Nonoperative management for hemodynamically normal patients with blunt splenic injury is feasible and safe, even in the presence of concurrent (non-hollow organ) injuries or a contrast blush on CT. However, associated injuries are related to prolonged intensive care unit- and hospital stay, complications, and failure of nonoperative management. Specifically, higher age and the presence of a femur fracture are predictors of failure.
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Metadata
Title
Safety of selective nonoperative management for blunt splenic trauma: the impact of concomitant injuries
Authors
Michel Paul Johan Teuben
Roy Spijkerman
Taco Johan Blokhuis
Roman Pfeifer
Henrik Teuber
Hans-Christoph Pape
Luke Petrus Hendrikus Leenen
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Patient Safety in Surgery / Issue 1/2018
Electronic ISSN: 1754-9493
DOI
https://doi.org/10.1186/s13037-018-0179-8

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