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      The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries : A systematic review and meta-analysis

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          Abstract

          Nonoperative management (NOM) of hemodynamically normal patients with blunt splenic injury (BSI) is the standard of care. Guidelines recommend additional splenic angioembolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) Grade IV and Grade V BSI, but the role of SAE in Grade III injuries is unclear and controversial. The aim of this systematic review was to compare the safety and effectiveness of SAE as an adjunct to NOM versus NOM alone in adults with BSI.

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          Bayesian methods in meta-analysis and evidence synthesis.

          A.J. Sutton, K.R. Abrams (2001)
          This paper reviews the use of Bayesian methods in meta-analysis. Whilst there has been an explosion in the use of meta-analysis over the last few years, driven mainly by the move towards evidence-based healthcare, so too Bayesian methods are being used increasingly within medical statistics. Whilst in many meta-analysis settings the Bayesian models used mirror those previously adopted in a frequentist formulation, there are a number of specific advantages conferred by the Bayesian approach. These include: full allowance for all parameter uncertainty in the model, the ability to include other pertinent information that would otherwise be excluded, and the ability to extend the models to accommodate more complex, but frequently occurring, scenarios. The Bayesian methods discussed are illustrated by means of a meta-analysis examining the evidence relating to electronic fetal heart rate monitoring and perinatal mortality in which evidence is available from a variety of sources.
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            Bayesian random effects meta-analysis of trials with binary outcomes: methods for the absolute risk difference and relative risk scales.

            D E Warn, S. Thompson, D J Spiegelhalter (2002)
            When conducting a meta-analysis of clinical trials with binary outcomes, a normal approximation for the summary treatment effect measure in each trial is inappropriate in the common situation where some of the trials in the meta-analysis are small, or the observed risks are close to 0 or 1. This problem can be avoided by making direct use of the binomial distribution within trials. A fully Bayesian method has already been developed for random effects meta-analysis on the log-odds scale using the BUGS implementation of Gibbs sampling. In this paper we demonstrate how this method can be extended to perform analyses on both the absolute and relative risk scales. Within each approach we exemplify how trial-level covariates, including underlying risk, can be considered. Data from 46 trials of the effect of single-dose ibuprofen on post-operative pain are analysed and the results contrasted with those derived from classical and Bayesian summary statistic methods. The clinical interpretation of the odds ratio scale is not straightforward. The advantages and flexibility of a fully Bayesian approach to meta-analysis of binary outcome data, considered on an absolute risk or relative risk scale, are now available. Copyright 2002 John Wiley & Sons, Ltd.
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              Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma.

              L Minei, G Tinkoff, R Bell … (2000)
              Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended chi2 test. Data are expressed as mean +/- SD; a value of p 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p < 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4% of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. In this multicenter study, 38.5% of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.
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                Author and article information

                Journal
                Title: Journal of Trauma and Acute Care Surgery
                Abbreviated Title: Journal of Trauma and Acute Care Surgery
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 2163-0755
                Publication date Created: 2017
                Publication date (Print): November 2017
                Volume: 83
                Issue: 5
                Pages: 934-943
                Article
                DOI: 10.1097/TA.0000000000001649
                PubMed ID: 29068875
                SO-VID: 6a280f61-4e10-4914-91aa-1b43dff76384
                Copyright © © 2017
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