368074University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
Department of Surgery, 22683Baylor University Medical Center, Dallas, TX, USA.
Am Surg. 2022 Apr;88(4):692-697. doi: 10.1177/00031348211048829. Epub 2021 Nov 3.
The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) to daily Hgb (DHgb) in this population.
We conducted a retrospective chart review of patients with BSI between 2013 and 2019. Demographics, comorbidities, lab values, clinical decisions, and outcomes were gathered through a trauma database.
A total of 562 patients arrive in the trauma bay with BSI. In the NOM group, 297 were successful and 37 failed NOM. Of those that failed NOM, 8 (21.6%) changed to OM due to a drop in Hgb. 5 (62.5%) were hypotensive first, 2 (25%) were no longer receiving SHgb, and 1 (12.5%) had a repeat CT scan and was embolized. DHgb patients were not significantly different from SHgb patients in injury severity, length of stay, the largest drop in Hgb, and incidence of failing NOM. Patients taking aspirin were more likely to fall below 7 g/dl at 48 and 72 hours into admission.
These results suggest that that trending SHgb may not influence clinical decision-making in NOM of BSI. Besides taking aspirin, risk factors for who would benefit from SHgb were not identified. Patients who received DHgb had similar injuries and outcomes than patients who received SHgb. Prospective studies are needed to evaluate the clinical utility of SHgb compared to DHgb.
东部创伤外科学会（EAST）指出，没有足够的证据推荐在非手术治疗（NOM）钝性脾损伤（BSI）时测量 Hgb 值的特定频率。本研究旨在比较连续 Hgb（SHgb）与每日 Hgb（DHgb）在该人群中的应用价值。
我们对 2013 年至 2019 年间患有 BSI 的患者进行了回顾性图表审查。通过创伤数据库收集了人口统计学、合并症、实验室值、临床决策和结局等信息。
共有 562 例患者因 BSI 到达创伤急救室。在 NOM 组中，297 例成功，37 例 NOM 失败。在 NOM 失败的患者中，有 8 例（21.6%）因 Hgb 下降而转为 OM。5 例（62.5%）首先出现低血压，2 例（25%）不再接受 SHgb，1 例（12.5%）进行了重复 CT 扫描并进行了栓塞。DHgb 患者与 SHgb 患者在损伤严重程度、住院时间、Hgb 最大下降量和 NOM 失败发生率方面无显著差异。服用阿司匹林的患者在入院后 48 小时和 72 小时更有可能降至 7g/dl 以下。
这些结果表明，SHgb 的趋势可能不会影响 BSI 的 NOM 临床决策。除了服用阿司匹林外，尚未确定谁将从 SHgb 中受益的危险因素。接受 DHgb 的患者与接受 SHgb 的患者具有相似的损伤和结局。需要前瞻性研究来评估 SHgb 与 DHgb 相比的临床应用价值。
