Failures of splenic nonoperative management

Is the glass half empty or half full?

Tiffany K. Bee, Martin Croce, Preston R. Miller, F. Elizabeth Pritchard, Kimberly A. Davis, Timothy Fabian

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Background: Published contraindications to nonoperative management (NOM) of blunt splenic injury (BSI) include age ≥ 55, Glasgow Coma Scale score ≤13, admission blood pressure < 100 mm Hg, major (grades 3-5) injuries, and large amounts of hemoperitoneum. Recently reported NOM rates approximate 60%, with failure rates of 10% to 15%. This study evaluated our failures of NOM for BSI relative to these clinical factors. Methods: All patients with BSI at a Level I trauma center over a 46-month period ending September 1999 were reviewed. Failures of NOM included patients initially selected for NOM who subsequently required splenectomy/splenorrhaphy. Results: Five hundred fifty-eight had BSI. Twenty-three percent (128) under-went emergent laparotomy for hemodynamic instability and 77% (430) were observed. The NOM failure rate was only 8%. Univariate analysis identified moderate to large hemoperitoneum (p < 0.03), grades 3 to 5 (p < 0.004), and age ≥ 55 (p < 0.0006) as being significantly associated with failure. Multivariate analysis identified age ≥ 55 and grades 3 to 5 injuries as independent predictors of failure. The highest failure rates (30-40%) occurred in patients age ≥ 55 with major injury for moderate to large hemoperitoneum. Mortality rates for successful NOM were 12%, and 9% for failed NOM. Conclusion: Inclusion of all high-risk patients increased the NOM rate while maintaining a low failure rate. Although age ≥55 and major BSI were independently associated with failure of NOM, approximately 80% of these high-risk patients were successfully managed nonoperatively. There was no increased mortality associated with failure. Although these factors may indeed predict failure, they do not necessarily contraindicate NOM.

Original languageEnglish (US)
Pages (from-to)230-236
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume50
Issue number2
DOIs
StatePublished - Jan 1 2001

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Nonpenetrating Wounds
Glass
Hemoperitoneum
Wounds and Injuries
Glasgow Coma Scale
Mortality
Trauma Centers
Splenectomy
Laparotomy
Multivariate Analysis
Hemodynamics
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Failures of splenic nonoperative management : Is the glass half empty or half full? / Bee, Tiffany K.; Croce, Martin; Miller, Preston R.; Pritchard, F. Elizabeth; Davis, Kimberly A.; Fabian, Timothy.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 50, No. 2, 01.01.2001, p. 230-236.

Research output: Contribution to journalArticle

Bee, Tiffany K. ; Croce, Martin ; Miller, Preston R. ; Pritchard, F. Elizabeth ; Davis, Kimberly A. ; Fabian, Timothy. / Failures of splenic nonoperative management : Is the glass half empty or half full?. In: Journal of Trauma - Injury, Infection and Critical Care. 2001 ; Vol. 50, No. 2. pp. 230-236.
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abstract = "Background: Published contraindications to nonoperative management (NOM) of blunt splenic injury (BSI) include age ≥ 55, Glasgow Coma Scale score ≤13, admission blood pressure < 100 mm Hg, major (grades 3-5) injuries, and large amounts of hemoperitoneum. Recently reported NOM rates approximate 60{\%}, with failure rates of 10{\%} to 15{\%}. This study evaluated our failures of NOM for BSI relative to these clinical factors. Methods: All patients with BSI at a Level I trauma center over a 46-month period ending September 1999 were reviewed. Failures of NOM included patients initially selected for NOM who subsequently required splenectomy/splenorrhaphy. Results: Five hundred fifty-eight had BSI. Twenty-three percent (128) under-went emergent laparotomy for hemodynamic instability and 77{\%} (430) were observed. The NOM failure rate was only 8{\%}. Univariate analysis identified moderate to large hemoperitoneum (p < 0.03), grades 3 to 5 (p < 0.004), and age ≥ 55 (p < 0.0006) as being significantly associated with failure. Multivariate analysis identified age ≥ 55 and grades 3 to 5 injuries as independent predictors of failure. The highest failure rates (30-40{\%}) occurred in patients age ≥ 55 with major injury for moderate to large hemoperitoneum. Mortality rates for successful NOM were 12{\%}, and 9{\%} for failed NOM. Conclusion: Inclusion of all high-risk patients increased the NOM rate while maintaining a low failure rate. Although age ≥55 and major BSI were independently associated with failure of NOM, approximately 80{\%} of these high-risk patients were successfully managed nonoperatively. There was no increased mortality associated with failure. Although these factors may indeed predict failure, they do not necessarily contraindicate NOM.",
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AU - Croce, Martin

AU - Miller, Preston R.

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AU - Fabian, Timothy

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