Zarzaur Ben L, Croce Martin A, Fabian Timothy C
Division of Trauma and Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
J Trauma. 2011 Nov;71(5):1333-9. doi: 10.1097/TA.0b013e318224d0e4.
Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI as well as the relationship between urgent splenectomy and in-hospital mortality.
The National Trauma Data Bank for 2007 was queried for adults (18-81) who suffered BSI. Patients who died in or were transferred from the emergency department were excluded. Hierarchical multivariate models were used to account for clustering of patients within hospitals and to identify hospital and patient factors associated with urgent splenectomy. Propensity score matching was used to analyze the relationship between urgent splenectomy and mortality.
There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4%). Hierarchical models revealed that age ≥55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma center level. The propensity-matched cohorts revealed no association between urgent splenectomy and in-hospital mortality (odds ratio, 1.08; 95% confidence interval, 0.82-1.42).
Despite ongoing variation in the use of urgent splenectomy after BSI in adults, urgent splenectomy was not associated with in-hospital mortality.
近期报告表明，创伤中心收治后的死亡率可能与钝性实性器官损伤后的手术干预率直接相关。这些发现使人质疑钝性脾损伤（BSI）后急诊脾切除术的作用。本研究的目的是确定急诊脾切除术（定义为入院后6小时内进行的脾切除术）在BSI治疗中的作用以及急诊脾切除术与院内死亡率之间的关系。
查询2007年国家创伤数据库中成年（18 - 81岁）BSI患者。排除在急诊科死亡或转出的患者。采用分层多变量模型来解释医院内患者的聚集情况，并确定与急诊脾切除术相关的医院和患者因素。使用倾向评分匹配法分析急诊脾切除术与死亡率之间的关系。
共识别出507,202起事件。其中，11,793例符合纳入标准。1,104例（9.4%）进行了急诊脾切除术。分层模型显示，年龄≥55岁、入院时收缩压≤90 mmHg、无或轻度头部损伤、损伤严重程度增加以及脾脏严重破裂与急诊脾切除术相关。与急诊脾切除术相关的医院水平因素包括医院所在地区、医院类型和创伤中心级别。倾向评分匹配队列显示急诊脾切除术与院内死亡率之间无关联（优势比，1.08；95%置信区间，0.82 - 1.42）。
尽管成人BSI后急诊脾切除术的使用仍存在差异，但急诊脾切除术与院内死亡率无关。
