Trauma Surgery & Acute Care Open (Mar 2024)
Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study
- Nikolay Bugaev,
- Jeffry Nahmias,
- Richard D Catalano,
- Claire Hardman,
- Daniel C Cullinane,
- Claire Pederson,
- Julianne B Ontengco,
- Anna Goldenberg,
- Chance Spalding,
- Lewis E Jacobson,
- Jamie M Williams,
- Matthew Noorbaksh,
- Catherine Garrison Velopulos,
- Shane Urban,
- John Chipko,
- Steven D Quarfordt,
- Caleb Mentzer,
- Saskya Byerly,
- Aimee K LaRiccia,
- Kristen Spoor,
- John David Cull,
- Banan W Otaibi,
- Joshua P Hazelton,
- Jessica Reynolds,
- Sam Fugate,
- Linda B Zier,
- Thomas S Easterday,
- Edward Hawke,
- Madison LeClair,
- Pascal Udekwu,
- Cooper Josephs,
- James Babowice,
- Gaby Ghobrial,
- John M Pickering,
- Alia F Aunchman,
- Jordan E Basham,
- Philip M Edmundson,
- Erika Tay,
- Scott H Norwood,
- Katelyn Meadows,
- Yee Wong
Affiliations
- Nikolay Bugaev
- Tufts Medical Center, Boston, Massachusetts, USA
- Jeffry Nahmias
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
- Richard D Catalano
- 8 Loma Linda University Medical Center, Loma Linda, California, USA
- Claire Hardman
- Department of Surgery, Wright State Physicians, Dayton, Ohio, USA
- Daniel C Cullinane
- Maine Medical Center, Portland, Maine, USA
- Claire Pederson
- Medical Center of the Rockies, Loveland, Colorado, USA
- Julianne B Ontengco
- 1 Surgery, Maine Medical Center, Portland, Maine, USA
- Anna Goldenberg
- Trauma, Acute Care Surgery, and Surgical Critical Care, Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA
- Chance Spalding
- Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA
- Lewis E Jacobson
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
- Jamie M Williams
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
- Matthew Noorbaksh
- 26 Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
- Catherine Garrison Velopulos
- Department of Surgery, University of Colorado Denver–Anschutz Medical Campus, Aurora, Colorado, USA
- Shane Urban
- Trauma Program, University of Colorado Health, Aurora, Colorado, USA
- John Chipko
- Research Medical Center, Kansas City, Missouri, USA
- Steven D Quarfordt
- Erlanger Health System, Chattanooga, Tennessee, USA
- Caleb Mentzer
- Department of Surgery, Spartanburg Regional, Spartanburg, South Carolina, USA
- Saskya Byerly
- Surgery, UTHSC COM, Memphis, Tennessee, USA
- Aimee K LaRiccia
- University of Vermont Medical Center, Burlington, Vermont, USA
- Kristen Spoor
- Department of Surgery, Saint Joseph Mercy Ann Arbor, Michigan, USA
- John David Cull
- Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
- Banan W Otaibi
- Pennsylvania State University, Hershey, Pennsylvania, USA
- Joshua P Hazelton
- Pennsylvania State University, Hershey, Pennsylvania, USA
- Jessica Reynolds
- University of Kentucky, Lexington, Kentucky, USA
- Sam Fugate
- University of Kentucky HealthCare, Lexington, Kentucky, USA
- Linda B Zier
- Medical Center of the Rockies, Loveland, Colorado, USA
- Thomas S Easterday
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Edward Hawke
- Spartanburg Regional Health System, Spartanburg, South Carolina, USA
- Madison LeClair
- Tufts Medical Center, Boston, Massachusetts, USA
- Pascal Udekwu
- Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
- Cooper Josephs
- WakeMed Health, Raleigh, North Carolina, USA
- James Babowice
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
- Gaby Ghobrial
- Cooper University Hospital, Camden, New Jersey, USA
- John M Pickering
- Erlanger Health System, Chattanooga, Tennessee, USA
- Alia F Aunchman
- University of Vermont Medical Center, Burlington, Vermont, USA
- Jordan E Basham
- Loma Linda University, Loma Linda, California, USA
- Philip M Edmundson
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
- Erika Tay
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
- Scott H Norwood
- UT Health East Texas, Tyler, Texas, USA
- Katelyn Meadows
- UT Health East Texas, Tyler, Texas, USA
- Yee Wong
- Premier Health Partners Inc, Dayton, Ohio, USA
- DOI
- https://doi.org/10.1136/tsaco-2023-001159
- Journal volume & issue
-
Vol. 9,
no. 1
Abstract
Objectives There is little evidence guiding the management of grade I–II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I–II splenic injuries with CB in hemodynamically stable patients.Methods A multicenter, retrospective cohort study examining all grade I–II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined the failure rate of NOM for grade I versus grade II splenic injuries. We then performed bivariate comparisons of patients who failed NOM with those who did not.Results A total of 145 patients were included. Median Injury Severity Score was 17. The combined rate of failure for grade I–II injuries was 20.0%. There was no statistical difference in failure of NOM between grade I and II injuries with CB (18.2% vs 21.1%, p>0.05). Patients who failed NOM had an increased median hospital length of stay (p=0.024) and increased need for blood transfusion (p=0.004) and massive transfusion (p=0.030). Five patients (3.4%) died and 96 (66.2%) were discharged home, with no differences between those who failed and those who did not fail NOM (both p>0.05).Conclusion NOM of grade I–II splenic injuries with CB fails in 20% of patients.Level of evidence IV.
