This is an outdated version published on 2023-12-18. Read the most recent version.

Nonoperative Management of Blunt Splenic injury at Maharat Nakhon Ratchasima

Authors

Jade Boonyawongvirot Surgery group Maharat Nakhon Ratchasima Hospital

Keywords:

Non-surgical treatment of patients with splenectomy, Blunt splenic injury

Abstract

This research aims to study the success rate and factor associated with success in treating splenic injuries without surgery. Patient with spleen injury caused by accidents that received services at Maharat Nakhon Ratchasima hospital within 5 years (2016 – 2020), totaling 492 cases. It is a cross-sectional study that studies data from retrospective medical records of patients. There were 6 factors indicating the success rate: gender, age, systolic blood pressure, pulse rate, injury severity score (ISS) and CT grading. Data were analyzed with descriptive statistics, z test for proportion and logistic regression.

The results of the study found a success rate in treating blunt splenic injury in 179 cases out of 492 cases, accounting for a rate of 36.4% (95% CI: 32.1, 40.8). And it was found that the success rate is closely related to patient age 16 – 55, with blood pressure greater than 120 mmHg, pulse rate over 100 time/second and CT grading levels I and II. The factor that is statistically to the success rate is the injury severity score, severity level I has a 50.00 times greater chance of successful treatment than severity levels III and IV (OR = 50.00; 95% CI: 20.00, 100.00).

Results form research, the success rate of NOM treatment for splenic injury in adults in Thailand is still lower than in other countries. Reviewing the definition of success and improving operational guidelines need to be considered.

References

Burlew CC, Moore EE, Anderson DK, Billiar TR, Dunn DL, Hunter JG, Matthew JB, Pollock RE, et al. Trauma in Brunicardi FC. Schwartz’s Principle of surgery. McGraw Hill. 2019;183-249.

Fodor M, Primavesi F, Morell-Hofert D, Kranebitter V, Palaver A, Braunwarth E, et al. Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years. World Journal of Emergency Surgery. 2019;14(29):1-12.

Johnsen NV, Betzold PD, Guillamondegui OD. Surgical management of solid organ injury. Surg Clin North AM. 2017;97(5):1077-105.

William BH, Minei JP, In Moore EE, Feliciano DV, Mattox KL. Spleen and Trauma, New York: McGraw Hill. 2017;575-95.

Beuran M, Gheju I, Venter MD, Marian RC, Marian RC, Smarandache R, Davila C, et al. Non-operative management of splenic trauma. Journal of Medicine and Life. 2012;5(1):47-58.

McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg. 2005;140(6):563-8.

Velmahos GC, Chan LS, Kamel E, Murray JA, Yassa N, Kaharu D, et al. Nonoperative management of splenic injuries: have we gone too far?. Arch Surg. 2000;135(6):674-9.

Guth AA, Pachter HL, Jacobowitz GR. Rupture of the pathologic spleen: is there a role for nonoperative therapy. J Trauma. 1996;41(2):214-8.

Feliciano DV, Bitondo CG, Mattox KL, Rumisek JD, Burch JM, Jordan Jr GL. A four-year experience with splenectomy versus splenorrhaphy. Ann Surg. 1985;201(5):568-75.

Moorrell DG, Chang FC, Helmer HD. Changing trend in management of splenic injury. Am J Surg. 1995;170(6):686-9.

Sclafani SJA, Shaftan GW, Scalea TM, Patterson LA, Kohl L, Kantor A, et al. Non-operative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma. 1995;39(5):818-25.

Kohn JS, Clark DE, Isler RJ, Pope CF. Is computed tomographic grading of selenic injury useful in nonsurgical management of blunt trauma. J Trauma. 1994;36(3):385-9.

Morse MA, Gracia VF. Selective nonoperative management of pediatric blunt splenic trauma: Risk of missed associated injury. J Pediatr Surg. 1994;29(1):23-7.

Andrea R, Fink MP, Raptopoulos V, Davivon A, Silva WE. Non operative treatment of adult splenic trauma: Development of a computer tomographic scorin system that detects appropriate candidate for expectant management. J Trauma. 1988;28(6):828-31.

Pearl RH, Wesson DE, Spence LJ, Filler RM, Ein SH, Shandling B, Superina RA, et al. Splenic injury: a 5-year update with improved results and changing criteria for conservative management. J Pediatr Surg. 1989 Jan;24(5):428-31.

Moore FA, Moore EE, Moore GE, Millikan JS. Risk of splenic salvage following trauma analysis of 200 adults. Am J Surg. 1984;148(6):800-5.

Frankle EL, Neu HC. Postsplenectomy infection. Surg Clin North AM 1981;61(1):135-55.

Pachter HL, Hofstetter SR, Speneer FC. Evolving concepts in splenic surgery: splenorrhaphy versus splenectomy and postsplenectomy drainage: experience in 105 patients. Ann Surg 1981;194(3):262-69.

Leonard AS, Giebink GS, Beasl TS. The overwhelming post splenectomy sepsis problem. 4th ed. World J surg. 1980;1423-28 p.

King H, Shumacker HB Jr. Splenic study1. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136(2):239-42.

Eraslis AJ, Kevy SV, Diamond LK, Gross RC. Harzard of overwhelming infection after splenectomy in childhood. N Eng J Med. 1967;276(22):1225-9.

Krivit W. Overwhelming postsplenectomy infection. Am J Hematol. 1977;2(2):193-201.

Buntain WL, Lynn HB. Splenorrhaphy: Changing concept for the traumatized spleen. Surgery. 1979;86(5):748-60.

Sherman R. Prospective in management of trauma to the spleen, Presidential address American Association for the Surgery of Trauma. J Trauma. 1980;20(1):1-13.