Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
J Trauma Acute Care Surg. 2012 Nov;73(5):1213-20. doi: 10.1097/TA.0b013e318265ccf0.
A strategy of prophylactic splenic angioembolization using observation failure risk (OFR) computed tomographic (CT) scan criteria has been proposed recently. The main aim of the present study was to evaluate the relevance of the criteria in terms of delayed splenic rupture in patients with blunt splenic injury.
All patients with blunt splenic injuries admitted consecutively between January 2005 and January 2010 to our institution were included. Clinical, CT scan, and angiographic data, initial management, and outcome were noted. Patients managed expectantly were classified according to OFR CT scan criteria (high OFR was defined by at least one of the following CT scan signs: blush, pseudoaneurysm, Organ Injury Scale [OIS] grade III with a large hemoperitoneum, and OIS grade IV or 5). Initial management success was especially studied.
Among the 208 patients included, 161 (77%) were treated by observation (35 OIS grade I, 64 OIS grade II, 33 OIS grade III, 18 OIS grade IV, and 11 OIS grade V) and 129 (80%) were men, with a mean (SD) age of 36.1 (18.7) years and a mean (SD) Injury Severity Score of 20.8 (15.4). Forty-nine patients (30%) had high OFR CT scan criteria. Thirteen patients (8%) experienced observation failure. High OFR CT scan criteria (odds ratio, 11; 95% confidence interval, 2.5-47.5) and patients 50 years and older (odds ratio, 33.9; 95% confidence interval, 6.2-185.5) were independent factors related to observation failure. The positive predictive value of OFR CT scan criteria for observation failure was 18%, and the negative predictive value was 96%. The corresponding values were 67% and 90%, respectively, in patients 50 years and older and 3% and 99%, respectively, in patients younger than 50 years.
OFR CT scan criteria lack specificity to predict observation failure, mainly in patients younger than 50 years. Age should be considered when identifying patients requiring prophylactic splenic angioembolization.
Diagnostic study, level III.
最近提出了一种使用观察失败风险（OFR）计算机断层（CT）扫描标准进行预防性脾动脉栓塞的策略。本研究的主要目的是评估这些标准在钝性脾损伤患者中延迟性脾破裂方面的相关性。
连续纳入 2005 年 1 月至 2010 年 1 月期间我院收治的所有钝性脾损伤患者。记录临床、CT 扫描和血管造影数据、初始治疗和结局。根据 OFR CT 扫描标准对接受观察治疗的患者进行分类（高 OFR 定义为至少存在以下 CT 扫描征象之一：充血、假性动脉瘤、器官损伤严重度评分（OIS）III 级伴大量血腹、OIS 级 IV 或 V 级）。特别研究了初始管理的成功。
在纳入的 208 例患者中，161 例（77%）接受了观察治疗（35 例 OIS 级 I，64 例 OIS 级 II，33 例 OIS 级 III，18 例 OIS 级 IV，11 例 OIS 级 V），129 例（80%）为男性，平均（标准差）年龄为 36.1（18.7）岁，平均（标准差）损伤严重度评分 20.8（15.4）。49 例（30%）患者有高 OFR CT 扫描标准。13 例（8%）患者出现观察治疗失败。高 OFR CT 扫描标准（比值比，11；95%置信区间，2.5-47.5）和 50 岁及以上患者（比值比，33.9；95%置信区间，6.2-185.5）是观察治疗失败的独立相关因素。OFR CT 扫描标准对观察治疗失败的阳性预测值为 18%，阴性预测值为 96%。在 50 岁及以上患者中，相应的数值分别为 67%和 90%，而在 50 岁以下患者中，相应的数值分别为 3%和 99%。
OFR CT 扫描标准特异性差，无法预测观察治疗失败，主要在 50 岁以下患者中。在确定需要预防性脾动脉栓塞的患者时应考虑年龄因素。
诊断研究，III 级。
