B45MTCRJ
type: UserItem
resource: Routine follow-up imaging has limited advantage in the non-operative management of blunt splenic injury in adult patients
tagged: UserTag
  label: Abdominal CT scan
tagged: UserTag
  label: Abdominal ultrasound
tagged: UserTag
  label: Adolescent
tagged: UserTag
  label: Adult
tagged: UserTag
  label: Aged
tagged: UserTag
  label: Aged, 80 and over
tagged: UserTag
  label: Blunt splenic injury
tagged: UserTag
  label: Delayed bleeding
tagged: UserTag
  label: Embolization, Therapeutic
tagged: UserTag
  label: Female
tagged: UserTag
  label: Follow-Up Studies
tagged: UserTag
  label: Follow-up imaging
tagged: UserTag
  label: Humans
tagged: UserTag
  label: Injury Severity Score
tagged: UserTag
  label: Male
tagged: UserTag
  label: Middle Aged
tagged: UserTag
  label: Non-operative management
tagged: UserTag
  label: Ongoing bleeding
tagged: UserTag
  label: Retrospective Studies
tagged: UserTag
  label: Risk
tagged: UserTag
  label: Spleen conserving surgery
tagged: UserTag
  label: Spleen/*diagnostic imaging/*injuries
tagged: UserTag
  label: Splenectomy
tagged: UserTag
  label: Splenic angio-embolization
tagged: UserTag
  label: Time Factors
tagged: UserTag
  label: Tomography, X-Ray Computed
tagged: UserTag
  label: Trauma Centers/*statistics & numerical data
tagged: UserTag
  label: Treatment Failure
tagged: UserTag
  label: Treatment Outcome
tagged: UserTag
  label: Ultrasonography
tagged: UserTag
  label: Wounds, Nonpenetrating/diagnosis/physiopathology/*therapy
tagged: UserTag
  label: Young Adult

Routine follow-up imaging has limited advantage in the non-operative management of blunt splenic injury in adult patients
type: AcademicArticle
abstract: BACKGROUND: To date, limited evidence exists regarding follow-up imaging during the non-operative management (NOM) of blunt splenic injury (BSI), especially concerning ultrasound as first-line imaging modality. The aim of this study was to investigate the incidence and time to failure of NOM as well as to evaluate the relevance of follow-up imaging. METHODS: All adult patients with BSI admitted to our level I trauma center, including two associated hospitals, between 01/01/2010 and 31/12/2017 were retrospectively analyzed. Demographic data, comorbidities, injury pattern, trauma mechanism, Injury Severity Score, splenic injury grade and free intra-abdominal fluid were reviewed. Additional analysis of indication, frequency, modality, results and consequences of follow-up imaging was performed. Risk factors for failure of NOM were evaluated using fisher's exact test. RESULTS: A total of 122 patients with a mean age of 43.8 +/- 20.7 years (16-84 years) met inclusion criteria. Twenty patients (16.4%) underwent immediate intervention. One-hundred-and-two patients (83.6%) were treated by NOM. Failure of NOM occurred in 4 patients (3.9%). Failure was significantly associated with active bleeding (3 of 4 [75%] failures vs. 8 of 98 [8.2%] non-failures, OR 33.75, 95% CI 3.1, 363.2, p = 0.004), and liver cirrhosis (2 of 4 [50%] failures vs. 0 of 98 [0%] non-failures, OR 197, 95% CI 7.4, 5265.1, p = 0.001). Eighty patients (78.4%) in the NOM-Group received follow-up imaging by ultrasound (US, n = 51) or computed tomography (CT, n = 29). In 57 cases, routine imaging examinations were conducted (43 US and 14 CT scans) without prior clinical deterioration. Fifty-fife (96.4%) of these imaging results revealed no new significant findings. Every failure of NOM was detected following clinical deterioration in the first 48 h. CONCLUSION: To our knowledge this study includes the largest single centric patient cohort undergoing ultrasound as first-line follow-up imaging modality in the NO…
pages: 863-870
doi: 10.1016/j.injury.2020.02.089
source: 32111461
creator: Person
author list: Person
is part of: Issue
  date: 2020-03-01
  volume: 51
  issue: 4
  is part of: Injury
    type: Journal
    issn: 1879-0267 (Electronic) 0020-1383 (Linking)

Person
given name: R.
surname: Liechti

Person
given name: L.
surname: Fourie

Person
given name: M.
surname: Stickel

Person
given name: S.
surname: Schrading

Person
given name: B. C.
surname: Link

Person
given name: H.
surname: Fischer

Person
given name: D.
surname: Lehnick

Person
given name: R.
surname: Babst

Person
given name: J.
surname: Metzger

Person
given name: F. J. P.
surname: Beeres