Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Am Surg. 2023 Aug;89(8):3411-3415. doi: 10.1177/00031348231161707. Epub 2023 Mar 9.
Blunt splenic injuries are common traumatic injuries. Severe injuries may require blood transfusion, procedural, or operative intervention. Conversely, patients with low-grade injuries and normal vital signs frequently do not require intervention. The level and duration of monitoring required to safely manage these patients are unclear. We hypothesize that low-grade splenic trauma has a low rate of intervention and may not require acute hospitalization.
This retrospective descriptive analysis included patients admitted to a level I trauma center with low injury burden (injury severity score <15) and The American Association for the Surgery of Trauma (AAST) grade 1 (G1) and 2 (G2) splenic injuries between January 2017 and December 2019 using the Trauma Registry of the American College of Surgeons (TRACS). The primary outcome was the need for any intervention. Secondary outcomes included time to intervention and length of stay.
107 patients met inclusion criteria. 87.9% required no intervention . 9.4% required blood products, with a median time to transfusion of 7.4 hours from arrival. All patients receiving blood products had extenuating circumstances such as bleeding from other injuries, anticoagulant use, or medical comorbidities. 2 patients required splenic artery embolization, one presenting with return precautions 9 days post-injury and 1 with significant comorbidities. One patient with concomitant bowel injury required splenectomy.
Low-grade blunt splenic trauma has a low rate of intervention, which typically occurs within the first 12 hours of presentation. This suggests that outpatient management with return precautions may be appropriate for select patients after a short interval of observation.
钝性脾损伤是常见的外伤性损伤。严重损伤可能需要输血、程序或手术干预。相反，具有低等级损伤和正常生命体征的患者通常不需要干预。管理这些患者所需的监测水平和持续时间尚不清楚。我们假设低等级脾外伤的干预率较低，可能不需要急性住院治疗。
本回顾性描述性分析纳入了 2017 年 1 月至 2019 年 12 月期间在 I 级创伤中心因低损伤负担（损伤严重程度评分 <15）和美国外科医师协会创伤分级（AAST）1 级（G1）和 2 级（G2）脾损伤而入院的患者，使用美国外科医师学院创伤登记处（TRACS）。主要结局是任何干预的需求。次要结局包括干预时间和住院时间。
107 例患者符合纳入标准。87.9%的患者无需干预。9.4%需要血液制品，从入院到输血的中位数时间为 7.4 小时。所有接受血液制品的患者都有特殊情况，如其他损伤出血、抗凝剂使用或合并症。2 例患者需要脾动脉栓塞，1 例在受伤后 9 天出现返回预防措施，1 例有严重合并症。1 例伴有肠损伤的患者需要脾切除术。
低等级钝性脾外伤的干预率较低，通常发生在就诊后的前 12 小时内。这表明，在短时间观察后，对于选择的患者，门诊管理并进行返回预防措施可能是合适的。
