Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India; Department of Trauma Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India.
Injury. 2021 Feb;52(2):260-265. doi: 10.1016/j.injury.2020.10.013. Epub 2020 Oct 3.
Despite the acceptance of non-operative management (NOM), there is no consensus on the optimal length of hospital stay in patients with blunt liver and splenic injury (BLSI). Recent studies on pediatric patients have demonstrated the safety of early discharge following NOM for BLSI. We aimed at evaluating the feasibility and safety of early discharge in adult patients with BLSI following NOM in a randomized controlled trial.
After initial assessment and management, patients aged 18-60 years with BLSI planned for NOM were randomized into 2 groups: Group A (test group; discharge day 3), and Group B (control group; discharge day 5). Standard NOM protocol was followed. These patients were discharged on the proposed day if they met the pre-defined discharge criteria. All patients were followed at days 7, 15, and 30 of discharge.
Sixty patients were recruited, 30 randomized to each arm. Most patients were males and aged less than 30 years. Road traffic injury was the most common mode of injury. Both groups were comparable in demography and injury-related parameters. 27 patients (90%) from group A and 28 patients (93%) from group B were discharged on the proposed day. Three patients had unplanned hospital visits for reasons unrelated to BLSI. All patients were asymptomatic and had a normal examination during their scheduled follow-up visits.
Adult patients undergoing NOM for BLSI can be safely discharged after 48 h of in-hospital observation, provided other injuries precluding discharge do not exist.
尽管非手术治疗（NOM）已被接受，但对于钝性肝脾损伤（BLSI）患者的最佳住院时间仍没有共识。最近对儿科患者的研究表明，在接受 NOM 治疗后，早期出院是安全的。我们旨在评估在一项随机对照试验中，对接受 NOM 的成人 BLSI 患者进行早期出院的可行性和安全性。
在初步评估和治疗后，将计划接受 NOM 的年龄在 18-60 岁之间的 BLSI 患者随机分为 2 组：A 组（试验组；出院第 3 天）和 B 组（对照组；出院第 5 天）。遵循标准的 NOM 方案。如果符合预定义的出院标准，这些患者将在建议的日期出院。所有患者均在出院后第 7、15 和 30 天进行随访。
共招募了 60 名患者，每组 30 名。大多数患者为男性，年龄小于 30 岁。道路交通伤是最常见的损伤模式。两组在人口统计学和损伤相关参数方面无差异。A 组有 27 名（90%）患者和 B 组有 28 名（93%）患者按计划在建议的日期出院。有 3 名患者因与 BLSI 无关的原因而计划外住院。所有患者在预定随访期间均无症状且体格检查正常。
对于接受 NOM 治疗的 BLSI 成人患者，如果不存在其他排除出院的损伤，可以在住院观察 48 小时后安全出院。
