MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44109-1998, USA.
J Trauma Acute Care Surg. 2013 Jul;75(1):69-74; discussion 74-5. doi: 10.1097/TA.0b013e3182988b3b.
This study aimed to evaluate if variation in management of blunt splenic injury (BSI) among Level I trauma centers is associated with different outcomes related to the use of splenic artery embolization (SAE).
All adult patients admitted for BSI from 2008 to 2010 at 4 Level I trauma centers were reviewed. Use of SAE was determined, and outcomes of spleen salvage and nonoperative management (NOM) failure were evaluated. A priori, a 10% SAE rate was used to group centers into high- or low-use groups.
There were 1,275 BSI patients. There were intercenter differences in age, injury severity, and grade of spleen injury (Spleen Injury Scale [SIS]). Mortality was similar by center; however, BSI treatment varied significantly by center. Overall, SAE use was highest at center A compared with B, C, and D (19%, 11%, 1%, and 4%, respectively; p < 0.01). High SAE use centers had significantly higher spleen salvage rates and fewer NOM failures. Differences in the use of SAE (25% vs. 2%, p < 0.01) and salvage rate (67% vs. 56%, p = 0.03) were most dramatic between high- and low-use SAE centers for Grade 3 and 4 injured spleens. In patients who received initial NOM, multivariate logistic regression analysis showed that SAE was an independent predictor of spleen salvage (odds ratio, 5; 95% confidence interval, 1.8-13.5; p < 0.01) as were lower age, lower SIS, and Injury Severity Score (ISS). Patients treated at high SAE use centers were more likely to leave the hospital with their spleen in situ (odds ratio, 3; 95% confidence interval, 1.7-6.3; p < 0.01).
Significant practice variation exists in the use of SAE in treating BSI at Level I trauma centers. Centers with higher rates of SAE use have higher spleen salvage and less NOM failure. SAE was shown to be an independent predictor of spleen salvage.
Therapeutic study, level IV.
本研究旨在评估一级创伤中心在处理钝性脾损伤（BSI）方面的管理差异是否与脾动脉栓塞（SAE）的使用相关的不同结果有关。
回顾了 2008 年至 2010 年在 4 个一级创伤中心因 BSI 入院的所有成年患者。确定了 SAE 的使用情况，并评估了保脾和非手术治疗（NOM）失败的结果。根据预先设定，10%的 SAE 使用率将中心分为高或低使用组。
共 1275 例 BSI 患者。各中心间的年龄、损伤严重程度和脾损伤分级（脾损伤评分[SIS]）存在差异。各中心间死亡率相似，但 BSI 治疗差异显著。总体而言，与 B、C 和 D 中心相比，A 中心的 SAE 使用率最高（分别为 19%、11%、1%和 4%；p < 0.01）。高 SAE 使用中心的保脾率显著更高，NOM 失败率更低。在 SAE 使用（25%比 2%，p < 0.01）和保脾率（67%比 56%，p = 0.03）方面差异最大的是 3 级和 4 级脾损伤的高 SAE 和低 SAE 中心。在接受初始 NOM 的患者中，多变量逻辑回归分析显示 SAE 是保脾的独立预测因素（优势比，5；95%置信区间，1.8-13.5；p < 0.01），年龄较低、SIS 较低和损伤严重程度评分（ISS）较低也是如此。在 SAE 使用较高的中心接受治疗的患者更有可能脾脏原位出院（优势比，3；95%置信区间，1.7-6.3；p < 0.01）。
一级创伤中心在使用 SAE 治疗 BSI 方面存在显著的实践差异。SAE 使用率较高的中心保脾率较高，NOM 失败率较低。SAE 是保脾的独立预测因素。
治疗性研究，IV 级。
