Strong evidence exists that an age of 40 years or above, Injury Severity Score (ISS) of 25 or greater, associated intra-abdominal injuries and hepatic/splenic injury grade III or higher are prognostic factors for failure of NOM. While the benefits of NOM are unquestionable, there is still a lack of consensus regarding patient stratification and potential risk factors for inapplicability or failure of NOM. NOM enables reduction of non-therapeutic laparotomies with potential intra-abdominal complications and unnecessary transfusion risks, thereby resulting in overall lower costs and decreased morbidity and mortality compared to OM. In practice, the choice between NOM or OM is mainly driven by hemodynamic considerations rather than the severity of organ injury. While NOM carries the risk of missed hollow visceral injuries or delayed bleeding, operative management (OM) is naturally associated with the possible side effects of any surgical intervention, depending on a variety of patient, medical, and technical factors. NOM has been described as a safe procedure when availability of experienced surgeons, modern imaging modalities, intensive care units (ICU), and other supporting services is assured. Ĭurrently, NOM is the standard of care in hemodynamically stable patients, which is associated with an estimated success rate exceeding 80–90%. Many technical advances in medicine allow to better diagnose and treat these kinds of injuries both with surgery or non-operative management (NOM), the latter usually also including radiological interventions. Abdominal organs are involved in approximately 30% of polytrauma patients, with the occurrence of hepatic and splenic injuries in 13 and 16%, respectively. The management of these injuries can be complex because of frequent association with a multifaceted picture of trauma, involving head, thoracic, and limb injuries. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management.Ĭompared to penetrating injuries, blunt abdominal trauma is very common in central European emergency departments. Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. This rate was quite constant over 17 years ( p = 0.515). NOM is the standard of care for blunt hepatic and splenic injuries and successful in > 96% of all patients. Our cohort represents one of the largest Central European single-center experiences available in the literature. These outcomes confirmed an improved utilization of the NOM approach. In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). The secondary failure rate of NOM was 3.3% and remained consistent over 17 years ( p = 0.515). Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Injury severity, clinical data on admission, operative and non-operative treatment parameters, complications, and in-hospital mortality were evaluated. MethodsĪ retrospective review of all emergency trauma patients admitted to the Medical University of Innsbruck from 2000 to 2016. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |