| The effects of splenic artery embolization on nonoperative management of blunt splenic injury: a 16-year experience. | |
| | |
MedLine Citation:
|
PMID: 19741401 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
INTRODUCTION: Nonoperative management (NOM) of blunt splenic injury has become the preferred treatment for hemodynamically stable patients. The application of splenic artery embolization (SAE) in NOM has been controversial. We hypothesized that incorporation of initial use of SAE into a practice protocol for patients at high risk for NOM failure (contrast extravasation or pseudoaneurysm on computed tomography, grade 3 injury with large hemoperitoneum, grade 4 injuries) would improve patient outcomes. METHODS: A retrospective analysis of three continuums of practice was performed: group I (January 1991-June 1998), SAE not part of routine NOM; group II (July 1998-December 2001), introduction and discretionary use of SAE; and group III (January 2002-June 2007), standardized use of initial SAE for patients considered at high risk of nonoperative failure. The primary outcome measure was the success of NOM. Failure of NOM was defined as the need for abdominal operation. Secondary outcomes were mortality, length of stay, and splenic salvage. RESULTS: Over 16 years, 815 patients with blunt splenic injury were treated at our level 1 trauma center. There were 222 patients in group I, 195 in group II, and 398 in group III. There was an increase in the use of SAE over time with a significant improvement in the utilization of NOM (61% in group I; 82% in group II; 88% in group III; p < 0.05). This was associated with an increase in successful NOM (77%, group I; 94%, group II; 97%, group III; p < 0.0001 group I vs. group II and III). Mortality, length of stay, and splenic salvage were similar in groups II and III but significantly improved when compared with group I. CONCLUSIONS: The increased use of initial SAE in high-risk patients expanded the successful use of NOM but was not associated with other incremental improvements. |
| | |
Authors:
|
Ashraf A Sabe; Jeffrey A Claridge; David I Rosenblum; Kevin Lie; Mark A Malangoni |
Publication Detail:
|
Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
|
Title: The Journal of trauma Volume: 67 ISSN: 1529-8809 ISO Abbreviation: - Publication Date: 2009 Sep |
Date Detail:
|
Created Date: 2009-09-10 Completed Date: 2009-09-29 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
|
Languages: eng Pagination: 565-72; discussion 571-2 Citation Subset: AIM; IM |
Affiliation:
|
Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Cohort Studies Embolization, Therapeutic* Female Humans Injury Severity Score Male Retrospective Studies Spleen / injuries* Splenic Artery* Treatment Outcome Wounds, Nonpenetrating / mortality, therapy* |
| Grant Support | |
ID/Acronym/Agency:
|
1KL2RR024990/RR/NCRR NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Does splenic preservation treatment (embolization, splenorrhaphy, and partial splenectomy) improve i...
Next Document: What's the incidence of delayed splenic bleeding in children after blunt trauma? An institutional ex...