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

机译：钝性脾外伤选择性非手术治疗的安全性：伴随伤害的影响

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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. 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. 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. 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.
机译：钝性脾损伤的非手术治疗是首选治疗方法。为了提高选择性非手术治疗的结果，当前的挑战是确定预测失败的因素。伴随伤害对预后的影响知之甚少。我们的研究有两个目标。首先，确定并发损伤是否影响选择性非手术治疗的安全性。其次，我们旨在确定可以预测故障的因素。从我们的前瞻性创伤登记中，我们选择了2000年1月1日至2013年12月12日之间收治的所有未经手术治疗的钝性脾外伤成年患者。对所有同时发生的AIS≥2的伤害进行评分。我们将遭受孤立性脾损伤的患者和伴有损伤的患者进行分组和比较。为了确定预测故障的特定因素，我们使用了多元回归分析。总共包括79名患者。非手术治疗失败（n = 11）和并发症仅发生在伴有损伤的患者中。此外，在存在相关损伤的情况下，重症监护病房的住院时间和住院时间均显着延长（4天比13天，p 0.05）。没有看到死亡率。多变量分析显示股骨骨折的存在和较高的年龄是失败的预测指标。对于血液动力学正常的钝性脾损伤患者，即使存在并发（非中空器官）损伤或CT上出现对比色腮红的情况，非手术治疗也是可行且安全的。但是，相关的伤害与延长的重症监护病房和住院时间，并发症以及非手术治疗的失败有关。具体而言，较高的年龄和股骨骨折的存在是失败的预兆。

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