Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
Scand J Trauma Resusc Emerg Med. 2019 Jan 11;27(1):4. doi: 10.1186/s13049-018-0578-y.
The long-term treatment trends of splenic injuries can provide guidance when treating trauma patients. The nonoperative management (NOM) of splenic injuries was introduced in early 1989. After decades of development, it has proven to be safe and is now the primary treatment choice worldwide. However, there remains a lack of nationwide registry data to support the feasibility and efficiency of NOM.
We used the Taiwan National Health Insurance Research Database to conduct a whole population-based cohort study. Patients admitted with blunt splenic injuries from 2002 to 2013 were identified. Demographic data, management methods, associated injuries, comorbidities and outcome parameters were collected. Patients were divided into 2 groups by the type of admitting institution: a tertiary center or a non-center hospital. We also used 4 years as an interval to analyze the changes in epidemiological data and treatment trends. Comparisons of the results of NOM and surgical management were also performed.
A total of 12,455 patients were admitted with blunt splenic injuries between 2002 and 2013. Among the 11,551 patients treated in a single hospital after admission, patients underwent NOM more frequently at tertiary centers than at non-center hospitals (64.6% vs 50.3%). During the 12-year study period, the NOM rate increased from 56 to 73% in tertiary centers, while in noncenter hospitals, the rate only increased from 43 to 58%. The mortality rate decreased in tertiary centers from 8.9 to 7.2%, with no apparent change in noncenter hospitals. Complications occurred more frequently in the surgical management group.
There is a trend toward the use of NOM for blunt splenic injury treatments, and the outcomes from the NOM groups were not inferior to those of the operation group. In addition, tertiary centers performed more NOM than did non-center hospitals and better met the international consensus.
脾脏损伤的长期治疗趋势可为创伤患者的治疗提供指导。1989 年初引入了脾脏损伤的非手术治疗（NOM）。经过几十年的发展，它已被证明是安全的，现在是全球主要的治疗选择。然而，仍然缺乏全国性的登记数据来支持 NOM 的可行性和效率。
我们使用台湾全民健康保险研究数据库进行了一项全人群队列研究。确定了 2002 年至 2013 年因钝性脾脏损伤入院的患者。收集了人口统计学数据、管理方法、相关损伤、合并症和结果参数。根据入院机构的类型将患者分为两组：三级中心或非中心医院。我们还使用 4 年的间隔来分析流行病学数据和治疗趋势的变化。还比较了 NOM 和手术治疗的结果。
2002 年至 2013 年期间，共有 12455 名患者因钝性脾脏损伤入院。在入院后在单一医院接受治疗的 11551 名患者中，三级中心比非中心医院更频繁地采用 NOM（64.6%比 50.3%）。在 12 年的研究期间，三级中心的 NOM 率从 56%增加到 73%，而非中心医院的 NOM 率仅从 43%增加到 58%。三级中心的死亡率从 8.9%降至 7.2%，而非中心医院则没有明显变化。手术治疗组的并发症发生率更高。
对于钝性脾脏损伤的治疗，NOM 的应用呈上升趋势，且 NOM 组的结果并不逊于手术组。此外，三级中心比非中心医院进行了更多的 NOM，更好地符合国际共识。
