Delayed complications of nonoperative management of blunt adult splenic trauma

Christine S Cocanour, Frederick A. Moore, Drue N. Ware, Robert G. Marvin, J. Michael Clark, James H. Duke

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Objective: To determine the incidence and type of delayed complications from nonoperative management of adult splenic injury. Design: Retrospective medical record review. University teaching hospital, level I trauma center. Patients: Two hundred eighty patients were admitted to the adult trauma service with blunt splenic injury during a 4-year period. Men constituted 66% of the population. The mean (±SEM) age was 32.2±1.0 years and the mean (±SEM) Injury Severity Score was 22.8±0.9. Fifty-nine patients (21%) died of multiple injuries within 48 hours and were eliminated from the study. One hundred thirty-four patients (48%) were treated operatively within the first 48 hours after injury and 87 patients (31%) were managed nonoperatively. Main Outcome Measures: We reviewed the number of units of blood transfused, intensive care unit length of stay, overall length of stay, outcome, and complications occurring more than 48 hours after injury directly attributable to the splenic injury. Results: Patients managed nonoperatively had a significantly lower Injury Severity Score (P<.05) than patients treated operatively. Length of stay was significantly decreased in both the number of intensive care unit days as well as total length of stay (P<.05). The number of units of blood transfused was also significantly decreased in patients managed nonoperatively (P<.05). Seven patients (8%) managed nonoperatively developed delayed complications requiring intervention. Five patients had overt bleeding that occurred at 4 days (3 patients), 6 days (1 patient), and 8 days (1 patient) after injury. Three patients underwent splenectomy, 1 had a splenic artery pseudoaneurysm embolization, and 1 had 2 areas of bleeding embolization. Two patients developed splenic abscesses at approximately I month after injury; both were treated by splenectomy. Conclusion: Significant numbers of delayed splenic complications do occur with nonoperative management of splenic injuries and are potentially life-threatening.

Original languageEnglish (US)
Pages (from-to)619-625
Number of pages7
JournalArchives of Surgery
Volume133
Issue number6
DOIs
StatePublished - Jun 1998
Externally publishedYes

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Wounds and Injuries
Length of Stay
Injury Severity Score
Splenectomy
Intensive Care Units
Hemorrhage
Splenic Artery
Nonpenetrating Wounds
Multiple Trauma
Trauma Centers
False Aneurysm
Teaching Hospitals
Abscess
Medical Records
Outcome Assessment (Health Care)
Incidence
Population

ASJC Scopus subject areas

  • Surgery

Cite this

Delayed complications of nonoperative management of blunt adult splenic trauma. / Cocanour, Christine S; Moore, Frederick A.; Ware, Drue N.; Marvin, Robert G.; Clark, J. Michael; Duke, James H.

In: Archives of Surgery, Vol. 133, No. 6, 06.1998, p. 619-625.

Research output: Contribution to journalArticle

Cocanour, Christine S ; Moore, Frederick A. ; Ware, Drue N. ; Marvin, Robert G. ; Clark, J. Michael ; Duke, James H. / Delayed complications of nonoperative management of blunt adult splenic trauma. In: Archives of Surgery. 1998 ; Vol. 133, No. 6. pp. 619-625.
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abstract = "Objective: To determine the incidence and type of delayed complications from nonoperative management of adult splenic injury. Design: Retrospective medical record review. University teaching hospital, level I trauma center. Patients: Two hundred eighty patients were admitted to the adult trauma service with blunt splenic injury during a 4-year period. Men constituted 66{\%} of the population. The mean (±SEM) age was 32.2±1.0 years and the mean (±SEM) Injury Severity Score was 22.8±0.9. Fifty-nine patients (21{\%}) died of multiple injuries within 48 hours and were eliminated from the study. One hundred thirty-four patients (48{\%}) were treated operatively within the first 48 hours after injury and 87 patients (31{\%}) were managed nonoperatively. Main Outcome Measures: We reviewed the number of units of blood transfused, intensive care unit length of stay, overall length of stay, outcome, and complications occurring more than 48 hours after injury directly attributable to the splenic injury. Results: Patients managed nonoperatively had a significantly lower Injury Severity Score (P<.05) than patients treated operatively. Length of stay was significantly decreased in both the number of intensive care unit days as well as total length of stay (P<.05). The number of units of blood transfused was also significantly decreased in patients managed nonoperatively (P<.05). Seven patients (8{\%}) managed nonoperatively developed delayed complications requiring intervention. Five patients had overt bleeding that occurred at 4 days (3 patients), 6 days (1 patient), and 8 days (1 patient) after injury. Three patients underwent splenectomy, 1 had a splenic artery pseudoaneurysm embolization, and 1 had 2 areas of bleeding embolization. Two patients developed splenic abscesses at approximately I month after injury; both were treated by splenectomy. Conclusion: Significant numbers of delayed splenic complications do occur with nonoperative management of splenic injuries and are potentially life-threatening.",
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