395
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      review-article
      1 , , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 1 , 3 , 9 , 10 , 11 , 12 , 13 , 50 , 14 , 15 , 15 , 16 , 17 , 18 , 19 , 19 , 20 , 21 , 22 , 23 , 24 , 1 , 1 , 25 , 25 , 1 , 1 , 1 , 1 , 26 , 27 , 28 , 29 , 1 , 1 , 30 , 10 , 31 , 32 , 33 , 10 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 43 , 44 , 45 , 1 , 46 , 47 , 48 , 49 , 1
      World Journal of Emergency Surgery : WJES
      BioMed Central
      Spleen, Trauma, Adult, Pediatric, Classification, Guidelines, Embolization, Surgery, Non-operative, Conservative

      Read this article at

      Bookmark
          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

          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.

          Related collections

          Most cited references200

          • Record: found
          • Abstract: found
          • Article: not found

          Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST).

          Thoracic ultrasound (EFAST) has shown promise in inferring the presence of post-traumatic pneumothoraces (PTXs) and may have a particular value in identifying occult pneumothoraces (OPTXs) missed by the AP supine chest radiograph (CXR). However, the diagnostic utility of hand-held US has not been previously evaluated in this role. Thoracic US examinations were performed during the initial resuscitation of injured patients at a provincial trauma referral center. A high frequency linear transducer and a 2.4 kg US attached to a video-recorder were used. Real-time EFAST examinations for PTXs were blindly compared with the subsequent results of CXRs, a composite standard (CXR, chest and abdominal CT scans, clinical course, and invasive interventions), and a CT gold standard (CT only). Charts were reviewed for in-hospital outcomes and follow-up. There were 225 eligible patients (207 blunt, 18 penetrating); 17 were excluded from the US examination because of battery failure or a lost probe. Sixty-five (65) PTXs were detected in 52 patients (22% of patients), 41 (63%) being occult to CXR in 33 patients (14.2% whole population, 24.6% of those with a CT). The US and CXR agreed in 186 (89.4%) of patients, EFAST was better in 16 (7.7%), and CXR better in 6 (2.9%). Compared with the composite standard, the sensitivity of EFAST was 58.9% with a likelihood ratio of a positive test (LR+) of 69.7 and a specificity of 99.1%. Comparing EFAST directly to CXR, by looking at each of 266 lung fields with the benefit of the CT gold standard, the EFAST showed higher sensitivity over CXR (48.8% versus 20.9%). Both exams had a very high specificity (99.6% and 98.7%), and very predictive LR+ (46.7 and 36.3). EFAST has comparable specificity to CXR but is more sensitive for the detection of OPTXs after trauma. Positive EFAST findings should be addressed either clinically or with CT depending on hemodynamic stability. CT should be used if detection of all PTXs is desired.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Organ injury scaling: spleen and liver (1994 revision).

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

              During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current EAST guideline. The National Library of Medicine and the National Institute of Health MEDLINE database was searched using Pub Med (www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords splenic injury and blunt abdominal trauma. One hundred seventy-six articles were reviewed, of which 125 were used to create the current practice management guideline for the selective nonoperative management of blunt splenic injury. There has been a plethora of literature regarding nonoperative management of blunt splenic injuries published since the original EAST practice management guideline was written. Nonoperative management of blunt splenic injuries is now the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury, patient age, or the presence of associated injuries. Its use is associated with a low overall morbidity and mortality when applied to an appropriate patient population. Nonoperative management of blunt splenic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and has an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt splenic injuries. Repeat imaging should be guided by a patient's clinical status. Adjunctive therapies like angiography with embolization are increasingly important adjuncts to nonoperative management of splenic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt splenic injuries remain without conclusive answers in the literature.
                Bookmark

                Author and article information

                Contributors
                +39-035-2673477 , federico.coccolini@gmail.com
                giulia.montori@gmail.com
                faustocatena@gmail.com
                y_kluger@rambam.health.gov.il
                wbiffl@Queens.Org
                Ernest.Moore@dhha.org
                vreva@mail.ru
                camibing@yahoo.it
                mikloshbala@gmail.com
                paola.fugazzola@gmail.com
                h_bahouth@rambam.health.gov.il
                marzi@trauma.uni-frankfurt.de
                GVELMAHOS@mgh.harvard.edu
                raoivatury@gmail.com
                ksoreide@me.com
                tal.horer@regionorebrolan.se
                Richard.tenBroek@radboudumc.nl
                drbrunompereira@gmail.com
                fragagp2008@gmail.com
                Kenji.Inaba@med.usc.edu
                jeffrykashuk@gmail.com
                Neil.Parry@lhsc.on.ca
                pmasiakos@partners.org
                KMYLONAS@mgh.harvard.edu
                Andrew.Kirkpatrick@albertahealthservices.ca
                fabuzidan@uaeu.ac.ae
                caxiaogomes@gmail.com
                sbenatti@asst-pg23.it
                noel.naidoo@gmail.com
                francisalvetti@gmail.com
                stefanomacca@me.com
                vanni.agnoletti@auslromagna.it
                egamberini74@gmail.com
                leonardosolaini@googlemail.com
                antocosta987@gmail.com
                ceil85@hotmail.com
                matteotomasoni83@gmail.com
                docvladimir@yandex.by
                carvieux@chu-grenoble.fr
                lenan@med.umich.ed
                lauri.handolin@pp.inet.fi
                mpisano@asst-pg23.it
                smagnone@asst-pg23.it
                dspain@stanford.edu
                mdemoya@mgh.harvard.edu
                kimberly.davis@yale.edu
                nic.deangelis@yahoo.it
                ari.leppaniemi@hus.fi
                paula.ferrada@vcuhealth.org
                Rifat.Latifi@wmchealth.org
                dcostacir@gmail.com
                clubtomo@me.com
                rcoimbra@ucsd.edu
                ronmaier@uw.edu
                Frederick.Moore@surgery.ufl.edu
                rizolis@smh.ca
                bsakakushev@gmail.com
                jmgalante@ucdavis.edu
                ochiara@yahoo.it
                scimbanassi@yahoo.it
                alainchichom@yahoo.com
                dietergweber@gmail.com
                marco.ceresoli89@gmail.com
                peitzmanab@upmc.edu
                drlibanwehliye@gmail.com
                massimosartelli@gmail.com
                salo75@inwind.it
                lansaloni@asst-pg23.it
                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central (London )
                1749-7922
                18 August 2017
                18 August 2017
                2017
                : 12
                : 40
                Affiliations
                [1 ]ISNI 0000 0004 1757 8431, GRID grid.460094.f, General, Emergency and Trauma Surgery, , Papa Giovanni XXIII Hospital, ; P.zza OMS 1, 24128 Bergamo, Italy
                [2 ]Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
                [3 ]ISNI 0000 0000 9950 8111, GRID grid.413731.3, Division of General Surgery, , Rambam Health Care Campus, ; Haifa, Israel
                [4 ]GRID grid.415594.8, Acute Care Surgery, , The Queen’s Medical Center, ; Honolulu, HI USA
                [5 ]ISNI 0000 0001 0369 638X, GRID grid.239638.5, Trauma Surgery, , Denver Health Medical Center, ; Denver, CO USA
                [6 ]General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
                [7 ]General and Emergency Surgery Department, Empoli Hospital, Empoli, Italy
                [8 ]ISNI 0000 0001 2221 2926, GRID grid.17788.31, General and Emergency Surgery, , Hadassah Medical Center, ; Jerusalem, Israel
                [9 ]ISNI 0000 0004 1936 9721, GRID grid.7839.5, , Klinik für Unfall-, Hand- und Wiederherstellungschirurgie Universitätsklinikum Goethe-Universität Frankfurt, ; Frankfurt, Germany
                [10 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Trauma, Emergency Surgery, and Surgical Critical Care, , Massachusetts General Hospital, ; Boston, MA USA
                [11 ]ISNI 0000 0004 0458 8737, GRID grid.224260.0, , Virginia Commonwealth University, ; Richmond, VA USA
                [12 ]ISNI 0000 0004 0627 2891, GRID grid.412835.9, Department of Gastrointestinal Surgery, , Stavanger University Hospital, ; Stavanger, Norway
                [13 ]ISNI 0000 0001 0123 6208, GRID grid.412367.5, Department of Cardiothoracic and Vascular Surgery, , Örebro University Hospital and Örebro University, ; Orebro, Sweden
                [14 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Department of Surgery, , Radboud University Nijmegen Medical Center, ; Nijmegen, Netherlands
                [15 ]ISNI 0000 0001 0723 2494, GRID grid.411087.b, Trauma/Acute Care Surgery and Surgical Critical Care, , University of Campinas, ; Campinas, Brazil
                [16 ]ISNI 0000 0001 0084 1895, GRID grid.411409.9, Division of Trauma and Critical Care, , LAC+USC Medical Center, ; Los Angeles, CA USA
                [17 ]ISNI 0000 0004 1937 0546, GRID grid.12136.37, Department of Surgery, Assia Medical Group, , Tel Aviv University Sackler School of Medicine, ; Tel Aviv, Israel
                [18 ]ISNI 0000 0004 0626 7267, GRID grid.416847.8, General and Trauma Surgery Department, London Health Sciences Centre, , Victoria Hospital, ; London, ON Canada
                [19 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Pediatric Trauma Service, , Massachusetts General Hospital, ; Boston, MA USA
                [20 ]ISNI 0000 0004 0469 2139, GRID grid.414959.4, General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, , Foothills Medical Centre, ; Calgary, AB Canada
                [21 ]ISNI 0000 0001 2193 6666, GRID grid.43519.3a, Department of Surgery, College of Medicine and Health Sciences, , UAE University, ; Al-Ain, United Arab Emirates
                [22 ]ISNI 0000 0001 2170 9332, GRID grid.411198.4, , Universidade Federal de Juiz de Fora, ; Juiz de Fora, Brazil
                [23 ]ISNI 0000 0004 1757 8431, GRID grid.460094.f, Infectivolgy Department, , Papa Giovanni XXIII Hospital, ; Bergamo, Italy
                [24 ]ISNI 0000 0001 0723 4123, GRID grid.16463.36, Department of Surgery, , University of KwaZulu-Natal, ; Durban, South Africa
                [25 ]ISNI 0000 0004 1758 8744, GRID grid.414682.d, Anesthesia Department, , Bufalini Hospital, ; Cesena, Italy
                [26 ]General Surgery Department, Mozir City Hospital, Mozir, Belarus
                [27 ]GRID grid.450307.5, , Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, ; Grenoble, France
                [28 ]ISNI 0000 0000 9081 2336, GRID grid.412590.b, Trauma and Surgical Critical Care, , University of Michigan Health System, ; East Medical Center Drive, Ann Arbor, MI USA
                [29 ]ISNI 0000 0000 9950 5666, GRID grid.15485.3d, Trauma Unit, , Helsinki University Hospital, ; Helsinki, Finland
                [30 ]ISNI 0000000419368956, GRID grid.168010.e, Department of Surgery, , Stanford University, ; Stanford, CA USA
                [31 ]GRID grid.417307.6, General Surgery, Trauma, and Surgical Critical Care, , Yale-New Haven Hospital, ; New Haven, CT USA
                [32 ]Hopital Heri Mondor, Paris, France
                [33 ]General Surgery Department, Mehilati Hospital, Helsinki, Finland
                [34 ]ISNI 0000 0004 0476 8324, GRID grid.417052.5, General Surgery Department, , Westchester Medical Center, ; Westchester, NY USA
                [35 ]Colorectal Surgery Unit, Trauma Care Committee, Alicante General University Hospital, Alicante, Spain
                [36 ]ISNI 0000 0001 1014 9130, GRID grid.265073.5, Trauma and Acute Critical Care Center, , Tokyo Medical and Dental University, ; Tokyo, Japan
                [37 ]GRID grid.420234.3, Department of Surgery, , UC San Diego Health System, ; San Diego, USA
                [38 ]ISNI 0000000122986657, GRID grid.34477.33, Department of Surgery, , University of Washington, ; Seattle, WA USA
                [39 ]Department of Surgery, Gainesville, FL USA
                [40 ]GRID grid.415502.7, Trauma and Acute Care Service, , St Michael’s Hospital, ; Toronto, ON Canada
                [41 ]ISNI 0000 0001 0726 0380, GRID grid.35371.33, General Surgery Department, , Medical University, University Hospital St George, ; Plovdiv, Bulgaria
                [42 ]ISNI 0000 0000 9752 8549, GRID grid.413079.8, Division of Trauma and Acute Care Surgery, , University of California, Davis Medical Center, ; Davis, CA USA
                [43 ]GRID grid.416200.1, Trauma Team, , Ospedale Niguarda, ; Milan, Italy
                [44 ]ISNI 0000 0001 2288 3199, GRID grid.29273.3d, Department of Surgery and Obstetric and Gynecology, , University of Buea, ; Buea, Cameroon
                [45 ]ISNI 0000 0004 0453 3875, GRID grid.416195.e, Department of General Surgery, , Royal Perth Hospital, ; Perth, Australia
                [46 ]ISNI 0000 0004 1936 9000, GRID grid.21925.3d, Surgery Department, , University of Pittsburgh, ; Pittsburgh, Pensylvania USA
                [47 ]General Surgery Department, Ayaan Hospital, Mogadisho, Somalia
                [48 ]General and Emergency Surgery, Macerata Hospital, Macerata, Italy
                [49 ]ISNI 0000 0004 1759 7093, GRID grid.416290.8, General, Emergency and Trauma Surgery Department, , Maggiore Hospital, ; Bologna, Italy
                [50 ]Department of Surgery, Örebro University Hospital and Örebro University, Obreo, Sweden
                Article
                151
                10.1186/s13017-017-0151-4
                5562999
                28828034
                fbe648b9-62eb-489c-a908-d0681c7d0c52
                © The Author(s). 2017

                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
                : 12 June 2017
                : 4 August 2017
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Surgery
                spleen,trauma,adult,pediatric,classification,guidelines,embolization,surgery,non-operative,conservative
                Surgery
                spleen, trauma, adult, pediatric, classification, guidelines, embolization, surgery, non-operative, conservative

                Comments

                Comment on this article