Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Could the Injury Severity Score be a new indicator for surgical treatment in patients with traumatic splenic injury?

  • Jeong, HyeJeong (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Jung, SungWon (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Heo, Tae Gil (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Choi, Pyong Wha (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Kim, Jae Il (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Jung, Sung Min (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Jun, Heungman (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Shin, Yong Chan (Department of Surgery, Inje University Ilsan Paik Hospital) ;
  • Um, Eunhae (Department of Surgery, Inje University Ilsan Paik Hospital)
  • Received : 2021.08.13
  • Accepted : 2021.09.30
  • Published : 2022.09.30
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Abstract

Purpose: The purpose of this study was to determine whether a higher Injury Severity Score (ISS) could serve as an indicator of splenectomy in patients with traumatic splenic lacerations. Methods: A total of 256 cases of splenic laceration were collected from January 1, 2005 to December 31, 2018. After the application of exclusion criteria, 105 were eligible for this study. Charts were reviewed for demographic characteristics, initial vital signs upon presentation to the emergency room, Glasgow Coma Scale, computed tomography findings, ISS, and treatment strategies. The cases were then divided into nonsplenectomy and splenectomy groups for analysis. Results: When analyzed with the chi-square test and t-test, splenectomy was associated with a systolic blood pressure lower than 90 mmHg, a Glasgow Coma Scale score lower than 13, active bleeding found on computed tomography, a splenic laceration grade greater than or equal to 4, and an ISS greater than 15 at presentation. However, in multivariate logistic regression analysis, only active bleeding on computed tomography showed a statistically significant relationship (P=0.014). Conclusions: Although ISS failed to show a statistically significant independent relationship with splenectomy, it may still play a supplementary role in traumatic splenic injury management.

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References

  1. Davis JJ, Cohn I Jr, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg 1976;183:672-8. https://doi.org/10.1097/00000658-197606000-00009
  2. Buzele R, Barbier L, Sauvanet A, Fantin B. Medical complications following splenectomy. J Visc Surg 2016;153:277-86. https://doi.org/10.1016/j.jviscsurg.2016.04.013
  3. Sampalis JS, Lavoie A, Boukas S, et al. Trauma center designation: initial impact on trauma-related mortality. J Trauma 1995;39:232-7. https://doi.org/10.1097/00005373-199508000-00008
  4. Rosati C, Ata A, Siskin GP, Megna D, Bonville DJ, Stain SC. Management of splenic trauma: a single institution's 8-year experience. Am J Surg 2015;209:308-14. https://doi.org/10.1016/j.amjsurg.2014.06.034
  5. Yousefzadeh Chabok S, Ranjbar Taklimie F, Malekpouri R, Razzaghi A. Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients. Chin J Traumatol 2017;20:339-42. https://doi.org/10.1016/j.cjtee.2017.04.011
  6. Bee TK, Croce MA, Miller PR, Pritchard FE, Fabian TC. Failures of splenic nonoperative management: is the glass half empty or half full. J Trauma 2001;50:230-6. https://doi.org/10.1097/00005373-200102000-00007
  7. McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg 2005;140:563-8. https://doi.org/10.1001/archsurg.140.6.563
  8. Albrecht RM, Schermer CR, Morris A. Nonoperative management of blunt splenic injuries: factors influencing success in age > 55 years. Am Surg 2002;68:227-30. https://doi.org/10.1177/000313480206800303
  9. Cocanour CS, Moore FA, Ware DN, Marvin RG, Duke JH. Age should not be a consideration for nonoperative management of blunt splenic injury. J Trauma 2000;48:606-10. https://doi.org/10.1097/00005373-200004000-00005
  10. Ochsner MG. Factors of failure for nonoperative management of blunt liver and splenic injuries. World J Surg 2001;25:1393-6. https://doi.org/10.1007/s00268-001-0138-9
  11. Cogbill TH, Moore EE, Jurkovich GJ, et al. Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma 1989;29:1312-7. https://doi.org/10.1097/00005373-198910000-00002
  12. Poletti PA, Mirvis SE, Shanmuganathan K, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography. J Trauma 2004;57:1072-81. https://doi.org/10.1097/01.TA.0000092680.73274.E1
  13. Zarzaur BL, Kozar R, Myers JG, et al. The splenic injury outcomes trial: an American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2015;79:335-42. https://doi.org/10.1097/TA.0000000000000782
  14. Schurr MJ, Fabian TC, Gavant M, et al. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma 1995;39:507-13.
  15. Omert LA, Salyer D, Dunham CM, Porter J, Silva A, Protetch J. Implications of the "contrast blush" finding on computed tomographic scan of the spleen in trauma. J Trauma 2001;51:272-7. https://doi.org/10.1097/00005373-200108000-00008
  16. Teuben MP, Spijkerman R, Blokhuis TJ, et al. Safety of selective nonoperative management for blunt splenic trauma: the impact of concomitant injuries. Patient Saf Surg 2018;12:32. https://doi.org/10.1186/s13037-018-0179-8
  17. 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. https://doi.org/10.1016/j.injury.2011.09.010
  18. Smith SR, Morris L, Spreadborough S, et al. Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study. Eur J Trauma Emerg Surg 2018;44:397-406. https://doi.org/10.1007/s00068-017-0807-5
  19. Olthof DC, Joosse P, van der Vlies CH, de Haan RJ, Goslings JC. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 2013;74:546-57. https://doi.org/10.1097/TA.0b013e31827d5e3a
  20. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma score and the injury severity score. J Trauma 1987;27:370-8. https://doi.org/10.1097/00005373-198704000-00005
  21. Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma 2000;49:177-8. https://doi.org/10.1097/00005373-200008000-00002
  22. Potoka DA, Schall LC, Ford HR. Risk factors for splenectomy in children with blunt splenic trauma. J Pediatr Surg 2002;37:294-9. https://doi.org/10.1053/jpsu.2002.30824
  23. Dent D, Alsabrook G, Erickson BA, et al. Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma 2004;56:1063-7. https://doi.org/10.1097/01.TA.0000123037.66867.F2