McIntyre Lisa K, Schiff Melissa, Jurkovich Gregory J
The Department of Surgery, University of Washington and the Harborview Injury Prevention Research Center, Seattle 98104, USA.
Arch Surg. 2005 Jun;140(6):563-8; discussion 568-9. doi: 10.1001/archsurg.140.6.563.
Presenting patient characteristics can predict which patients will fail nonoperative therapy of blunt splenic injuries.
Retrospective descriptive population study.
All patients admitted with blunt splenic trauma were identified from a statewide trauma registry between January 1, 1995, and December 31, 2001.
Patients were characterized as requiring immediate intervention or successful or failed nonoperative management based on time from emergency department arrival to intervention (surgery or angioembolectomy). Injury and patient characteristics included age, the presence of hypotension, Injury Severity Score, and the Glasgow Coma Scale score. Risk factors for the failure of nonoperative management were evaluated using the chi(2) statistic. The failure of nonoperative management associated with the admitting hospital's trauma designation level was evaluated using logistic regression.
None.
Determine factors associated with failure of nonoperative management of blunt splenic injuries.
Two thousand two hundred forty-three patients met criteria for inclusion in the study. Six hundred ten patients (27%) underwent immediate splenectomy, splenorrhaphy, or splenic embolization (within 4 hours). Of the remaining 1633 patients who were admitted with planned nonoperative management, 252 patients (15%) failed. Of the injury and patient characteristics reviewed, being older than 55 years and having an ISS higher than 25 were significantly associated with failure. Risk of failure also increased with admission to a level III or IV trauma hospital compared with a level I trauma hospital.
Being older than 55 years and having an ISS higher than 25 along with admission to a level III or IV trauma hospital were associated with a significant risk of failure of nonoperative management of splenic injuries. The Glasgow Coma Scale score, associated injuries, and presenting hemodynamics were not predictive of failure in this large retrospective review.
呈现的患者特征可预测哪些患者钝性脾损伤非手术治疗会失败。
回顾性描述性人群研究。
1995年1月1日至2001年12月31日期间，从全州创伤登记处确定了所有因钝性脾外伤入院的患者。
根据从急诊科就诊到干预（手术或血管栓塞术）的时间，将患者分为需要立即干预或非手术治疗成功或失败。损伤和患者特征包括年龄、低血压情况、损伤严重程度评分和格拉斯哥昏迷量表评分。使用卡方统计评估非手术治疗失败的危险因素。使用逻辑回归评估与收治医院创伤指定级别相关的非手术治疗失败情况。
无。
确定与钝性脾损伤非手术治疗失败相关的因素。
2243例患者符合纳入本研究的标准。610例患者（27%）接受了立即脾切除术、脾修补术或脾栓塞术（4小时内）。其余1633例计划进行非手术治疗入院的患者中，252例（15%）治疗失败。在审查所涉及 的损伤和患者特征中，年龄大于55岁和损伤严重程度评分高于25与治疗失败显著相关。与I级创伤医院相比，入住III级或IV级创伤医院时治疗失败风险也增加。
年龄大于55岁、损伤严重程度评分高于25以及入住III级或IV级创伤医院与脾损伤非手术治疗失败的显著风险相关。在这项大型回顾性研究中，格拉斯哥昏迷量表评分、相关损伤和就诊时的血流动力学情况不能预测治疗失败。
