Blunt splenic injury in adults

Multi-institutional study of the Eastern Association for the Surgery of Trauma

Andrew B. Peitzman, Brian Heil, Louis Rivera, Michael B. Federle, Brian G. Harbrecht, Keith D. Clancy, Martin Croce, Blaine L. Enderson, John A. Morris, David Shatz, J. Wayne Meredith, Juan B. Ochoa, Samir M. Fakhry, James G. Cushman, Joseph P. Minei, Mary McCarthy, Fred A. Luchette, Ricard Townsend, Glenn Tinkoff, Ernest F J Block & 12 others Steven Ross, Eric R. Frykberg, Richard M. Bell, Frank Davis, Leonard Weireter, Michael B. Shapiro, G. Patrick Kealey, Fred Rogers, Larry M. Jones, John B. Cone, C. Michael Dunham, Clyde E. McAuley

Research output: Contribution to journalArticle

319 Citations (Scopus)

Abstract

Background: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. Methods: A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended χ 2 test. Data are expressed as mean ± SD; a value of p < 0.05 was considered significant. Results: A total of 38.5% of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) < 15 and 46.6% of patients with ISS > 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p < 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4 % of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. Conclusion: In this multicenter study, 38.5 % of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.

Original languageEnglish (US)
Pages (from-to)177-189
Number of pages13
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume49
Issue number2
StatePublished - 2000

Fingerprint

Nonpenetrating Wounds
Hemoperitoneum
Wounds and Injuries
Laparotomy
Observation
Glasgow Coma Scale
Trauma Centers
Hematocrit
Multicenter Studies
Analysis of Variance
Spleen
Hypertension

ASJC Scopus subject areas

  • Surgery

Cite this

Peitzman, A. B., Heil, B., Rivera, L., Federle, M. B., Harbrecht, B. G., Clancy, K. D., ... McAuley, C. E. (2000). Blunt splenic injury in adults: Multi-institutional study of the Eastern Association for the Surgery of Trauma. Journal of Trauma - Injury, Infection and Critical Care, 49(2), 177-189.

Blunt splenic injury in adults : Multi-institutional study of the Eastern Association for the Surgery of Trauma. / Peitzman, Andrew B.; Heil, Brian; Rivera, Louis; Federle, Michael B.; Harbrecht, Brian G.; Clancy, Keith D.; Croce, Martin; Enderson, Blaine L.; Morris, John A.; Shatz, David; Meredith, J. Wayne; Ochoa, Juan B.; Fakhry, Samir M.; Cushman, James G.; Minei, Joseph P.; McCarthy, Mary; Luchette, Fred A.; Townsend, Ricard; Tinkoff, Glenn; Block, Ernest F J; Ross, Steven; Frykberg, Eric R.; Bell, Richard M.; Davis, Frank; Weireter, Leonard; Shapiro, Michael B.; Kealey, G. Patrick; Rogers, Fred; Jones, Larry M.; Cone, John B.; Dunham, C. Michael; McAuley, Clyde E.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 49, No. 2, 2000, p. 177-189.

Research output: Contribution to journalArticle

Peitzman, AB, Heil, B, Rivera, L, Federle, MB, Harbrecht, BG, Clancy, KD, Croce, M, Enderson, BL, Morris, JA, Shatz, D, Meredith, JW, Ochoa, JB, Fakhry, SM, Cushman, JG, Minei, JP, McCarthy, M, Luchette, FA, Townsend, R, Tinkoff, G, Block, EFJ, Ross, S, Frykberg, ER, Bell, RM, Davis, F, Weireter, L, Shapiro, MB, Kealey, GP, Rogers, F, Jones, LM, Cone, JB, Dunham, CM & McAuley, CE 2000, 'Blunt splenic injury in adults: Multi-institutional study of the Eastern Association for the Surgery of Trauma', Journal of Trauma - Injury, Infection and Critical Care, vol. 49, no. 2, pp. 177-189.
Peitzman, Andrew B. ; Heil, Brian ; Rivera, Louis ; Federle, Michael B. ; Harbrecht, Brian G. ; Clancy, Keith D. ; Croce, Martin ; Enderson, Blaine L. ; Morris, John A. ; Shatz, David ; Meredith, J. Wayne ; Ochoa, Juan B. ; Fakhry, Samir M. ; Cushman, James G. ; Minei, Joseph P. ; McCarthy, Mary ; Luchette, Fred A. ; Townsend, Ricard ; Tinkoff, Glenn ; Block, Ernest F J ; Ross, Steven ; Frykberg, Eric R. ; Bell, Richard M. ; Davis, Frank ; Weireter, Leonard ; Shapiro, Michael B. ; Kealey, G. Patrick ; Rogers, Fred ; Jones, Larry M. ; Cone, John B. ; Dunham, C. Michael ; McAuley, Clyde E. / Blunt splenic injury in adults : Multi-institutional study of the Eastern Association for the Surgery of Trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 2000 ; Vol. 49, No. 2. pp. 177-189.
@article{77eb9b2a29c24829893bf992e1b813b7,
title = "Blunt splenic injury in adults: Multi-institutional study of the Eastern Association for the Surgery of Trauma",
abstract = "Background: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. Methods: A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended χ 2 test. Data are expressed as mean ± SD; a value of p < 0.05 was considered significant. Results: A total of 38.5{\%} of patients went directly to the operating room (group I); 61.5{\%} of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8{\%} failed and required laparotomy; 82.1{\%} of patients with an Injury Severity Score (ISS) < 15 and 46.6{\%} of patients with ISS > 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9{\%}), II (22.4{\%}), III (38.1{\%}), IV (73.7{\%}), and V (94.9{\%}) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8{\%}), II (9.5{\%}), III (19.6{\%}), IV (33.3{\%}), and V (75.0{\%}) (p < 0.05). A total of 60.9{\%} of the patients failed nonoperative management within 24 hours of admission; 8{\%} failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9{\%} of patients with small hemoperitoneum, 49.4 {\%} of patients with moderate hemoperitoneum, and 72.6{\%} of patients with large hemoperitoneum. Conclusion: In this multicenter study, 38.5 {\%} of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8{\%} of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8{\%}, with 60.9{\%} of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.",
author = "Peitzman, {Andrew B.} and Brian Heil and Louis Rivera and Federle, {Michael B.} and Harbrecht, {Brian G.} and Clancy, {Keith D.} and Martin Croce and Enderson, {Blaine L.} and Morris, {John A.} and David Shatz and Meredith, {J. Wayne} and Ochoa, {Juan B.} and Fakhry, {Samir M.} and Cushman, {James G.} and Minei, {Joseph P.} and Mary McCarthy and Luchette, {Fred A.} and Ricard Townsend and Glenn Tinkoff and Block, {Ernest F J} and Steven Ross and Frykberg, {Eric R.} and Bell, {Richard M.} and Frank Davis and Leonard Weireter and Shapiro, {Michael B.} and Kealey, {G. Patrick} and Fred Rogers and Jones, {Larry M.} and Cone, {John B.} and Dunham, {C. Michael} and McAuley, {Clyde E.}",
year = "2000",
language = "English (US)",
volume = "49",
pages = "177--189",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Blunt splenic injury in adults

T2 - Multi-institutional study of the Eastern Association for the Surgery of Trauma

AU - Peitzman, Andrew B.

AU - Heil, Brian

AU - Rivera, Louis

AU - Federle, Michael B.

AU - Harbrecht, Brian G.

AU - Clancy, Keith D.

AU - Croce, Martin

AU - Enderson, Blaine L.

AU - Morris, John A.

AU - Shatz, David

AU - Meredith, J. Wayne

AU - Ochoa, Juan B.

AU - Fakhry, Samir M.

AU - Cushman, James G.

AU - Minei, Joseph P.

AU - McCarthy, Mary

AU - Luchette, Fred A.

AU - Townsend, Ricard

AU - Tinkoff, Glenn

AU - Block, Ernest F J

AU - Ross, Steven

AU - Frykberg, Eric R.

AU - Bell, Richard M.

AU - Davis, Frank

AU - Weireter, Leonard

AU - Shapiro, Michael B.

AU - Kealey, G. Patrick

AU - Rogers, Fred

AU - Jones, Larry M.

AU - Cone, John B.

AU - Dunham, C. Michael

AU - McAuley, Clyde E.

PY - 2000

Y1 - 2000

N2 - Background: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. Methods: A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended χ 2 test. Data are expressed as mean ± SD; a value of p < 0.05 was considered significant. Results: A total of 38.5% of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) < 15 and 46.6% of patients with ISS > 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p < 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4 % of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. Conclusion: In this multicenter study, 38.5 % of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.

AB - Background: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. Methods: A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended χ 2 test. Data are expressed as mean ± SD; a value of p < 0.05 was considered significant. Results: A total of 38.5% of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) < 15 and 46.6% of patients with ISS > 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p < 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4 % of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. Conclusion: In this multicenter study, 38.5 % of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.

UR - http://www.scopus.com/inward/record.url?scp=0033821154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033821154&partnerID=8YFLogxK

M3 - Article

VL - 49

SP - 177

EP - 189

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -