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Prospective evaluation of criteria for the nonoperative management of blunt splenic trauma
Abstracts The abstracts and commentaries in this issue were prepared by editorial board members of the Year Book of Emergency Medicine. These selections will appear in the 2004 volume. To order a copy of the entire 2004 Year Book of Emergency Medicine, call Elsevier Inc.’s toll-free number 800453-4351 or 314-453-4351 outside the United States. Commentaries appearing in Annals of Emergency Medicine may undergo additional editing by the Annals abstract editor.
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Prospective Evaluation of Criteria for the Nonoperative Management of Blunt Splenic Trauma Meguid AA, Bair HA, Howells GA, et al (William Beaumont Hospital, Royal Oak, MI) Am Surg. 2003;69:238-243
Background: There has been significant evolution in the management of blunt splenic trauma over the past 30 years. The trend toward nonoperative management of blunt splenic injury in adults has now been accepted as the standard of care in pediatric patients as well. However, recent reports have shown increased mortality rates and failure rates associated with nonoperative management of blunt splenic injury and have prompted questions regarding the appropriate criteria for nonoperative management. The authors of this study have prospectively applied criteria developed from 15 years of experience in the nonoperative management of blunt splenic injury. These criteria are hemodynamic stability on admission or after initial resuscitation with up to 2 L of crystalloid infusion, no physical findings or any associated injuries necessitating laparotomy, and a transfusion requirement attributable to the splenic injury of 2 units or less. The most recent results with application of these criteria to the treatment of blunt splenic trauma are presented.
namic instability, leaving 68 patients for inclusion in this report. Results: During the observation period, 8 (12%) of the 68 patients who initially met criteria for nonoperative management had hemodynamic instability develop and underwent splenectomy. All the nonoperative management failures occurred within 72 hours of admission. There was no mortality associated with splenic injury in the nonoperative management group or in the group that failed nonoperative management, and neither group had associated morbidities from the splenic injury. There were no significant differences between the nonoperative management group and the failed nonoperative management group in terms of demographics, clinical findings, or outcome measures. Conclusions: It would appear from these findings that established criteria for intervention and careful observation in an intensive care setting for a minimum of 72 hours will reduce the morbidity or mortality associated with blunt splenic trauma in adults. Comment: Meguid et al present compelling evidence that: (1) nonoperative management of blunt splenic trauma is safe if strict patient selection criteria are observed and careful monitoring systems are in place and (2) outcomes are similar even if initial nonoperative management fails and surgery is required. R. K. Cydulka, MD, MS doi:10.1016/j.annemergmed.2003.10.019
Methods: From 1994 through 2000, a total of 99 patients presented with splenic injury. Of these patients, 31 (31%) patients underwent splenectomy resulting from hemody-
Copyright © 2004 by Elsevier, Inc. All rights reserved.
JANUARY 2004
43:1
ANNALS OF EMERGENCY MEDICINE
1 4 3
Reprints not available.
Prospective Evaluation of Criteria for the Nonoperative Management of Blunt Splenic Trauma Meguid AA, Bair HA, Howells GA, et al (William Beaumont Hospital, Royal Oak, MI) Am Surg. 2003;69:238-243
Background: There has been significant evolution in the management of blunt splenic trauma over the past 30 years. The trend toward nonoperative management of blunt splenic injury in adults has now been accepted as the standard of care in pediatric patients as well. However, recent reports have shown increased mortality rates and failure rates associated with nonoperative management of blunt splenic injury and have prompted questions regarding the appropriate criteria for nonoperative management. The authors of this study have prospectively applied criteria developed from 15 years of experience in the nonoperative management of blunt splenic injury. These criteria are hemodynamic stability on admission or after initial resuscitation with up to 2 L of crystalloid infusion, no physical findings or any associated injuries necessitating laparotomy, and a transfusion requirement attributable to the splenic injury of 2 units or less. The most recent results with application of these criteria to the treatment of blunt splenic trauma are presented.
namic instability, leaving 68 patients for inclusion in this report. Results: During the observation period, 8 (12%) of the 68 patients who initially met criteria for nonoperative management had hemodynamic instability develop and underwent splenectomy. All the nonoperative management failures occurred within 72 hours of admission. There was no mortality associated with splenic injury in the nonoperative management group or in the group that failed nonoperative management, and neither group had associated morbidities from the splenic injury. There were no significant differences between the nonoperative management group and the failed nonoperative management group in terms of demographics, clinical findings, or outcome measures. Conclusions: It would appear from these findings that established criteria for intervention and careful observation in an intensive care setting for a minimum of 72 hours will reduce the morbidity or mortality associated with blunt splenic trauma in adults. Comment: Meguid et al present compelling evidence that: (1) nonoperative management of blunt splenic trauma is safe if strict patient selection criteria are observed and careful monitoring systems are in place and (2) outcomes are similar even if initial nonoperative management fails and surgery is required. R. K. Cydulka, MD, MS doi:10.1016/j.annemergmed.2003.10.019
Methods: From 1994 through 2000, a total of 99 patients presented with splenic injury. Of these patients, 31 (31%) patients underwent splenectomy resulting from hemody-
Copyright © 2004 by Elsevier, Inc. All rights reserved.
JANUARY 2004
43:1
ANNALS OF EMERGENCY MEDICINE
1 4 3