Division of Trauma, Department of Surgery and the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada.
Injury. 2012 Jan;43(1):55-61. doi: 10.1016/j.injury.2010.09.007. Epub 2010 Oct 22.
The technologic innovations of the last three decades, coupled with a deeper understanding of the immunologic role of the spleen, have significantly shifted the management of splenic injuries towards non-operative approaches. However, there continuous to be a wide range of practice patterns related to the non-operative management of splenic injuries, from which the authors infer a gap between the best available evidence and its translation into practice. We sought to explore ongoing areas of controversy in the non-operative management of splenic trauma with the aim of further elucidating why these controversies continue to exist.
We explored areas of ongoing controversy in the management of splenic injury though a series of iterative surveys. We invited 70 experts in trauma care from ten countries around the world to participate. Areas of controversy explored included: indications and frequency for in-hospital and follow-up imaging, definitions of failure of non-operative management, indications for angioembolisation and non-operative management in special populations (i.e. elderly, concomitant traumatic brain injury, penetrating trauma).
A 49% response rate was obtained. Even though a wide range of practice patterns were identified, no controversies were identified in areas that do not involve the adoption of new technologies. In areas where practice pattern variation was observed, the strong influence of the local environment was constantly identified as an impediment to changes in practice.
We have identified that barriers present within local practice environments are the major driving forces behind controversies in the non-operative management of splenic injuries.
过去三十年的技术创新，加上对脾脏免疫作用的深入了解，使得脾损伤的处理方式明显向非手术方法转变。然而，非手术治疗脾损伤的实践模式仍存在广泛差异，作者据此推断最佳可用证据与其在实践中的转化之间存在差距。我们试图通过一系列迭代调查来探讨非手术治疗脾外伤中持续存在的争议领域，旨在进一步阐明这些争议持续存在的原因。
我们通过一系列迭代调查来探讨脾损伤管理中的持续争议领域。我们邀请了来自全球十个国家的 70 名创伤护理专家参与。探讨的争议领域包括：住院期间和随访影像学的适应证和频率、非手术治疗失败的定义、血管栓塞术和特殊人群（如老年人、合并创伤性脑损伤、穿透性创伤）中非手术治疗的适应证。
我们获得了 49%的回复率。尽管确定了广泛的实践模式，但在不涉及新技术采用的领域没有发现争议。在观察到实践模式变化的领域，当地环境的强烈影响经常被确定为实践改变的障碍。
我们已经确定，当地实践环境中存在的障碍是脾损伤非手术治疗中争议的主要驱动因素。
