| Nonoperative Management of Adult Blunt Splenic Injury With and Without Splenic Artery Embolotherapy: A Meta-Analysis. | |
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MedLine Citation:
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PMID: 21986737 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND:: Observation and splenic artery embolotherapy (SAE) are nonoperative management (NOM) modalities for adult blunt splenic injury; however, they are quite different, inconsistently applied, and controversial. This meta-analysis compares the known outcomes data for observational management versus SAE by splenic injury grade cohort. METHODS:: Thirty-three blunt splenic injury outcomes articles, published between 1994 and 2009, comprising 24 unique data sets are identified. Of these, nine gave outcomes data by splenic injury grade for observational management and SAE separately. Failure rates were collected and analyzed using random effects estimates. RESULTS:: Overall, 68.4% of the 10,157 patients were managed nonoperatively. The overall failure rate estimate of NOM is 8.3% with a 95% confidence interval (CI) of 6.7% to 10.2%. The observational management failure rate estimate without SAE increases from 4.7% to 83.1% in splenic injury grade 1 to 5 patients. The overall failure rate estimate of SAE is 15.7% (95% CI, 10.4-23.2) and did not vary significantly from splenic injury grades 1 to 5 (p = 0.413). The failure rate of observational management without SAE is statistically higher than the failure rare estimate of SAE in splenic injury grade 4 and 5 injuries: 43.7% (95% CI, 25.5-63.8) versus 17.3% (95% CI, 7.8-34.1), p = 0.035 and 83.1% (95% CI, 45.2-96.7) versus 25.0% (95% CI, 8.7-53.8), p = 0.016, respectively. CONCLUSIONS:: This meta-analysis synthesizes NOM outcomes data by modality and splenic injury grade. The failure rate of observational management increases with splenic injury grade, whereas the failure rate of SAE does not change significantly. SAE is associated with significantly higher splenic salvage rates in splenic injury grade 4 and 5 injuries. |
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Authors:
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Jay A Requarth; Ralph B Dʼagostino; Preston R Miller |
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Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: The Journal of trauma Volume: 71 ISSN: 1529-8809 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-10-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: - |
Other Details:
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Languages: ENG Pagination: 898-903 Citation Subset: - |
Affiliation:
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From the Section of Vascular and Interventional Radiology (J.A.R.), Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina; Division of Public Health Sciences (R.B.D.A.), Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston Salem, North Carolina; and Department of Surgery (P.R.M.), Wake Forest University Baptist Medical Center, Winston Salem, North Carolina. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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