Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center.

Methods

A retrospective review of all emergency trauma patients admitted to the Medical University of Innsbruck from 2000 to 2016. Injury severity, clinical data on admission, operative and non-operative treatment parameters, complications, and in-hospital mortality were evaluated.

Results

In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. The secondary failure rate of NOM was 3.3% and remained consistent over 17 years ( p = 0.515). In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). These outcomes confirmed an improved utilization of the NOM approach.

Conclusion

Our cohort represents one of the largest Central European single-center experiences available in the literature. NOM is the standard of care for blunt hepatic and splenic injuries and successful in > 96% of all patients. This rate was quite constant over 17 years ( p = 0.515). Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management.

Electronic supplementary material

The online version of this article (10.1186/s13017-019-0249-y) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 26

Record: found
Abstract: found
Article: not found

Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy

Herbert Schöchl, Ulrike Nienaber, Marc Maegele … (2011)

Introduction Thromboelastometry (TEM)-guided haemostatic therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in trauma patients may reduce the need for transfusion of red blood cells (RBC) or platelet concentrate, compared with fresh frozen plasma (FFP)-based haemostatic therapy. Methods This retrospective analysis compared patients from the Salzburg Trauma Centre (Salzburg, Austria) treated with fibrinogen concentrate and/or PCC, but no FFP (fibrinogen-PCC group, n = 80), and patients from the TraumaRegister DGU receiving ≥ 2 units of FFP, but no fibrinogen concentrate/PCC (FFP group, n = 601). Inclusion criteria were: age 18-70 years, base deficit at admission ≥2 mmol/L, injury severity score (ISS) ≥16, abbreviated injury scale for thorax and/or abdomen and/or extremity ≥3, and for head/neck < 5. Results For haemostatic therapy in the emergency room and during surgery, the FFP group (ISS 35.5 ± 10.5) received a median of 6 units of FFP (range: 2, 51), while the fibrinogen-PCC group (ISS 35.2 ± 12.5) received medians of 6 g of fibrinogen concentrate (range: 0, 15) and 1200 U of PCC (range: 0, 6600). RBC transfusion was avoided in 29% of patients in the fibrinogen-PCC group compared with only 3% in the FFP group (P< 0.001). Transfusion of platelet concentrate was avoided in 91% of patients in the fibrinogen-PCC group, compared with 56% in the FFP group (P< 0.001). Mortality was comparable between groups: 7.5% in the fibrinogen-PCC group and 10.0% in the FFP group (P = 0.69). Conclusions TEM-guided haemostatic therapy with fibrinogen concentrate and PCC reduced the exposure of trauma patients to allogeneic blood products.

0 comments Cited 104 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

Federico Coccolini, Giulia Montori, Fausto Catena … (2017)

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

0 comments Cited 88 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Organ injury scaling: spleen, liver, and kidney.

Brian Champion, Sophie E. Moore, T Gennarelli … (1989)

The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) was appointed by President Trunkey at the 1987 Annual Meeting. The principal charge was to devise injury severity scores for individual organs to facilitate clinical research. The resultant classification scheme is fundamentally an anatomic description, scaled from 1 to 5, representing the least to the most severe injury. A number of similar scales have been developed in the past, but none has been uniformly adopted. In fact, this concept was introduced at the A.A.S.T. in 1979 as the Abdominal Trauma Index (A.T.I.) and has proved useful in several areas of clinical research. The enclosed O.I.S.'s for spleen, liver, and kidney represent an amalgamation of previous scales applied for these organs, and a consensus of the O.I.S. Committee as well as the A.A.S.T. Board of Managers. The O.I.S. differs from the Abbreviated Injury Score (A.I.S.), which is also based on an anatomic scale but designed to reflect the impact of a specific organ injury on ultimate patient outcome. The individual A.I.S.'s are, of course, the basic elements used to calculate the Injury Severity Score (I.S.S.) as well as T.R.I.S.S. methodology. To ensure that the O.I.S. interdiffuses with the A.I.S. and I.C.D.-9 codes, these are listed alongside the respective O.I.S. Both the currently used A.I.S. 85 and proposed A.I.S. 90 are provided because of the obligatory transition period. Indeed, A.I.S. 90 contains the identical descriptive text as the current O.I.S.'s. The Abdominal Trauma Index and other similar indices using organ injury scoring can be easily modified by replacing older scores with the O.I.S.'s.(ABSTRACT TRUNCATED AT 250 WORDS)

0 comments Cited 66 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Stefan Stättner:

ORCID: http://orcid.org/0000-0002-5226-7597

+43 512 504 22600 , stefan.staettner@i-med.ac.at

Journal

Journal ID (nlm-ta): World J Emerg Surg

Journal ID (iso-abbrev): World J Emerg Surg

Title: World Journal of Emergency Surgery : WJES

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-7922

Publication date (Electronic): 17 June 2019

Publication date PMC-release: 17 June 2019

Publication date Collection: 2019

Volume: 14

Electronic Location Identifier: 29

Affiliations

[1 ]ISNI 0000 0000 8853 2677, GRID grid.5361.1, Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, , Medical University of Innsbruck, ; Anichstraße 35, 6020 Innsbruck, Austria

[2 ]ISNI 0000 0000 8853 2677, GRID grid.5361.1, Department of Radiology, , Medical University of Innsbruck, ; Innsbruck, Austria

[3 ]ISNI 0000 0000 8853 2677, GRID grid.5361.1, Department of Trauma Surgery, Center of Operative Medicine, , Medical University of Innsbruck, ; Innsbruck, Austria

[4 ]ISNI 0000000123222966, GRID grid.6936.a, Department of Surgery, Klinikum Rechts der Isar, , Technical University of Munich, ; Munich, Germany

[5 ]ISNI 0000 0000 8853 2677, GRID grid.5361.1, Department of General and Surgical Intensive Care Medicine, , Medical University of Innsbruck, ; Innsbruck, Austria

Author information

Stefan Stättner http://orcid.org/0000-0002-5226-7597

Article

Publisher ID: 249

DOI: 10.1186/s13017-019-0249-y

PMC ID: 6580509

PubMed ID: 31236129

SO-VID: 8f294790-7976-4a90-88d5-87c773665d20

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 March 2019

Date accepted : 4 June 2019

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: blunt abdominal trauma,non-operative management,safety measures

Data availability:

ScienceOpen disciplines: Surgery

Keywords: blunt abdominal trauma, non-operative management, safety measures

Comments

Comment on this article

scite_

Cited by 18

See all cited by

Most referenced authors 536

See all reference authors

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

Read this article at

Abstract

Background

Methods

Results

Conclusion

Electronic supplementary material

Related collections

25th European Students' Conference

Most cited references 26

Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

Organ injury scaling: spleen, liver, and kidney.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 224

Cited by 18

Most referenced authors 536