Salottolo Kristin, Madayag Robert M, O'Brien Michael, Yon James, Tanner Allen, Topham Andrew, Lieser Mark, Carrick Matthew M, Mains Charles W, Bar-Or David
Trauma Research, Swedish Medical Center, Englewood, Colorado, USA.
St. Anthony Hospital, Lakewood, Colorado, USA.
Trauma Surg Acute Care Open. 2020 Feb 9;5(1):e000406. doi: 10.1136/tsaco-2019-000406. eCollection 2020.
In patients with hemodynamically stable blunt splenic injury (BSI), there is no consensus on whether quantity of hemoperitoneum (HP) is a predictor for intervention with splenic artery embolization (SAE) or failing nonoperative management (fNOM). We sought to analyze whether the quantity of HP was associated with need for intervention.
This retrospective cohort study included adult trauma patients with hemodynamically stable BSI admitted to six trauma centers between 2014 and 2016. Quantity of HP was defined as small (perisplenic blood or blood in Morrison's pouch), moderate (blood in one or both pericolic gutters), or large (additional finding of free blood in the pelvis). Multivariate logistic regression was performed to identify predictors of intervention with SAE or fNOM versus successful observation.
There were 360 patients: hemoperitoneum was noted in 214 (59%) patients, of which the quantity was small in 92 (43%), moderate in 76 (35.5%), and large in 46 (21.5%). Definitive management was as follows: 272 (76%) were observed and 88 (24%) had intervention (83 SAE, 5 fNOM). The rate of intervention was univariately associated with quantity of HP, even after stratification by American Association for the Surgery of Trauma (AAST) grade. After adjustment, larger quantities of HP significantly increased odds of intervention (p=0.01). Compared with no HP, the odds of intervention were significantly increased for moderate HP (OR=3.51 (1.49 to 8.26)) and large HP (OR=2.89 (1.03 to 8.06)), with similar odds for small HP (OR=1.21 (0.46 to 2.76)). Other independent predictors of intervention were higher AAST grade, older age, and presence of splenic vascular injury.
Greater quantity of HP was associated with increased odds of intervention, with no difference in risk for moderate versus large HP. These findings suggest quantity of HP should be incorporated in the management algorithm of BSI as a consideration for angiography and/or embolization to maximize splenic preservation and reduce the risk of splenic rupture.
III, retrospective epidemiological study.
在血流动力学稳定的钝性脾损伤（BSI）患者中，对于腹腔积血（HP）的量是否可作为脾动脉栓塞术（SAE）干预或非手术治疗失败（fNOM）的预测指标尚无共识。我们旨在分析HP的量是否与干预需求相关。
这项回顾性队列研究纳入了2014年至2016年间入住6个创伤中心的血流动力学稳定的成年BSI创伤患者。HP的量被定义为少量（脾周血液或莫里森隐窝内血液）、中等量（一个或两个结肠旁沟内血液）或大量（盆腔内有游离血液这一额外发现）。进行多因素逻辑回归以确定SAE或fNOM干预与成功观察的预测因素。
共有360例患者：214例（59%）患者发现有腹腔积血，其中92例（43%）量少，76例（35.5%）量中等，46例（21.5%）量多。确定性治疗如下：272例（76%）接受观察，88例（24%）接受干预（83例SAE，5例fNOM）。即使按美国创伤外科学会（AAST）分级进行分层后，干预率与HP的量单因素相关。调整后，HP量较大显著增加干预几率（p=0.01）。与无HP相比，中等量HP（OR=3.51（1.49至8.26））和大量HP（OR=2.89（1.03至8.06））的干预几率显著增加，少量HP的干预几率相似（OR=1.21（0.46至2.76））。其他干预的独立预测因素为较高的AAST分级、年龄较大和存在脾血管损伤。
HP量越大，干预几率越高，中等量HP与大量HP的风险无差异。这些发现表明，HP的量应纳入BSI的管理算法中，作为血管造影和/或栓塞的考虑因素，以最大限度地保留脾脏并降低脾破裂风险。
III，回顾性流行病学研究。
