Department of Trauma, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA.
Am J Surg. 2013 Mar;205(3):298-301. doi: 10.1016/j.amjsurg.2012.10.022. Epub 2013 Jan 22.
There is no consensus when the designation of nonoperative management (NOM) for splenic injury (BSI) should start. We evaluated NOM success rates based on different time points after admission.
The National Trauma Data Bank was evaluated for BSI for the year 2008. Observations were evaluated by facility, the time to splenectomy, and the volume of BSI admissions.
Of 15,732 BSIs identified, the overall splenectomy salvage rate was 81%. After the 5th hour, the NOM success rate was 95%. Multivariable analysis revealed that higher BSI grades, level 2 centers and community hospitals, and age ≥55 were associated with failed NOM.
The grade of injury is an important predictor for failure of NOM. If a 5% failure rate is to be considered a benchmark, then the 5-hour time point after admission should be used for the calculation of NOM success rates.
对于脾损伤（BSI）何时开始非手术治疗（NOM）尚无共识。我们根据入院后不同时间点评估 NOM 的成功率。
评估了国家创伤数据库 2008 年的 BSI。通过医疗机构、脾切除术时间和 BSI 入院量来评估观察结果。
在确定的 15732 例 BSI 中，整体脾切除术保脾率为 81%。第 5 小时后，NOM 的成功率为 95%。多变量分析显示，较高的 BSI 分级、2 级中心和社区医院以及年龄≥55 岁与 NOM 失败相关。
损伤程度是 NOM 失败的重要预测因素。如果将 5%的失败率视为基准，则应在入院后 5 小时计算 NOM 成功率。
