Journal of Emergencies, Trauma, and Shock
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LETTERS TO EDITOR  
Year : 2020  |  Volume : 13  |  Issue : 4  |  Page : 319-320
Predictors of failure of nonoperative management in spleen trauma


Department of General Surgery, Traumatology and Severe Burns Center, Ben Arous, University of Tunis El Manar, Tunis, Tunisia

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Date of Submission06-May-2020
Date of Acceptance25-May-2020
Date of Web Publication7-Dec-2020
 

How to cite this article:
Zenaidi H, Ismail IB, Rebii S, Zoghlami A. Predictors of failure of nonoperative management in spleen trauma. J Emerg Trauma Shock 2020;13:319-20

How to cite this URL:
Zenaidi H, Ismail IB, Rebii S, Zoghlami A. Predictors of failure of nonoperative management in spleen trauma. J Emerg Trauma Shock [serial online] 2020 [cited 2021 Jan 18];13:319-20. Available from: https://www.onlinejets.org/text.asp?2020/13/4/319/302522




Sir,

The standard treatment of choice for hemodynamically stable patients with blunt splenic trauma is currently, nonoperative management (NOM), thanks to the development in intensive care units and the improvement of computed tomography and angioembolization technique.[1] However, the indications and criteria for successful (NOM) remain controversial. The study is aimed to evaluate the feasibility of conservative treatment and to identify the main predictor factors of NOM to choose the most appropriate therapeutic attitude.

A retrospective multivariate regression analysis was carried out of 100 patients with injury to the spleen between 2013 and 2018. A total of 100 patients were identified (80 men and 20 women) with a median age of 36 ± 15.75 years. In 59 cases, spleen lesions were associated with other intra-abdominal involvement mainly in the liver (57.6%) and kidneys (50.8%). Nine patients were admitted for penetrating splenic trauma, among which three had an attempt of NOM, which was successful in two-thirds of the cases. Ninety-one patients were admitted for blunt splenic trauma with an attempt of NOM in 81.3% of cases and a success rate of 86.5%. Our analytical study [Table 1] found that predictors of NOM failure were age ≥55 years (P = 0.011), SBP at admission <100 mmHg (P = 0.000071), or shock on admission (P = 0.028), a transfusion of three units or more of packed red cells (PRC) (P = 0.0029), as well as associated pancreatic injury (P = 0.00018) or intra-abdominal hollow organ injury (P = 0.01). As a result of the multivariate logistic regression analysis [Table 2], SBP <100 mmHg (odds ratio [OR] = 1.293; 95% confidence interval [CI] = 1.045–1.601; P = 0.018) and blood transfusion >3 PRC (OR = 2.739; 95% CI = 1.140–6.581; P = 0.024) were determined to be independent predictive factors for the failure of NOM.
Table 1: Univariate analysis of patient and trauma characteristics

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Table 2: Results of the multivariate logistic regression analysis

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NOM means surgical observation with a serial physical examination, serial computed tomography, or angiographic embolization. The overall success rate reported in the literature ranged from 78% to 98%.[2] In our study, the success rate was 86.5%. Several studies determined a correlation between failed NOM and statistically significantly lower SBP in admission.[3],[4] and higher requirement in blood transfusion in the first 24 h.[5] Special attention should be paid to these patients when they are treated with NOM approaches.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Dembele BT, Kante L, Traore A, Togo A, Diakite I, Camara M, et al. Traumatismes de la rate dans le service de chirurgie générale du CHU Gabriel Touré. J Afr Hépatol Gastroentérol 2014;8:152-5.  Back to cited text no. 1
    
2.
Watson GA, Rosengart MR, Zenati MS, Tsung A, Forsythe RM, Peitzman AB, et al. Nonoperative management of severe blunt splenic injury: Are we getting better? Aust N Z J Surg 2006;61:1113-9.  Back to cited text no. 2
    
3.
Gonzalez M, Bucher P, Ris F, Andereggen E, Morel P. Splenic trauma: Predictive factors for failure of non-operative management. J Chir (Paris) 2008;145:561-7.  Back to cited text no. 3
    
4.
Bhangu A, Nepogodiev D, Lal N, Bowley DM. Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma. Injury 2012;43:1337-46.  Back to cited text no. 4
    
5.
Maull KI. Current status of nonoperative management of liver injuries. World J Surg 2001;25:1403-4.  Back to cited text no. 5
    

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Correspondence Address:
Imen Ben Ismail
Rue Du 1er Mai Cité El Iskan 2013 Ben Arous, Ben Arous
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_60_20

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