Tidadini Fatah, Martinet Eugenie, Quesada Jean-Louis, Foote Alison, El Wafir Chayma, Girard Edouard, Arvieux Catherine
Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital (CHU), Grenoble, 38043, France.
Department of digestive surgery, Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC, Grenoble, 38000, France.
Emerg Radiol. 2024 Dec;31(6):823-833. doi: 10.1007/s10140-024-02285-3. Epub 2024 Oct 4.
Non-operative management of hemodynamically stable patients with splenic trauma has been recommended for more than 25 years, but in practice embolization and/or splenectomy (intervention) is often needed within the first 30 days. Identifying the risk factors associated with the need for intervention could support more individualized decision-making.
We used data from the SPLASH randomized clinical trial, a comparison of outcomes of surveillance or embolization. 140 patients were randomized, 133 retained in the study (embolization n = 66; surveillance n = 67) and 103 screened and registered in the non-inclusion register. Multivariate Cox proportional hazards models with time-varying covariates were used to identify risk factors contributing to embolization and/or splenectomy within 30 days after initiating surveillance only for splenic trauma.
123 patients (median age, 30 [23; 48] years; 91 (74%) male) initially received non-operative management. At the day-30 visit, 34 (27.6%) patients had undergone an intervention (31 (25.2%) delayed embolization and 4 (3.3%) splenectomy). Multivariate analysis identified patients with OIS grade 4 or 5 splenic trauma (HR = 4.51 [2.06-9.88]) and (HR = 34.5 [6.84-174]); respectively) and splenic complications: arterial leak (HR = 1.80 [1.45-2.24]), pseudoaneurysm (HR = 1.22 [1.06-1.40]) and pseudocyst (HR = 1.41 [1.21-1.64]) to be independently associated with increased risk of need for an intervention within 30 days of initiating surveillance.
Our study shows that more than 1 in 4 patients who received non-operative management needed embolization or splenectomy by day 30. Arterial leak, pseudoaneurysm, pseudocyst, and OIS grade 4 or 5 were independent risk factors linked to the need for an intervention.
clinicaltrials.gov Identifier NCT02021396.
25年多来一直推荐对血流动力学稳定的脾外伤患者进行非手术治疗，但实际上在最初30天内通常需要进行栓塞和/或脾切除术（干预）。识别与干预需求相关的风险因素有助于做出更个性化的决策。
我们使用了SPLASH随机临床试验的数据，该试验比较了监测或栓塞的结果。140例患者被随机分组，133例留在研究中（栓塞组n = 66；监测组n = 67），103例被筛查并登记在非纳入登记册中。使用具有时变协变量的多变量Cox比例风险模型来识别仅针对脾外伤开始监测后30天内导致栓塞和/或脾切除术的风险因素。
123例患者（中位年龄30[23；48]岁；91例（74%）为男性）最初接受非手术治疗。在第30天就诊时，34例（27.6%）患者接受了干预（31例（25.2%）延迟栓塞和4例（3.3%）脾切除术）。多变量分析确定，器官损伤严重度评分（OIS）4级或5级脾外伤患者（风险比[HR]=4.51[2.06 - 9.88]）和（HR = 34.5[6.84 - 174]）；以及脾并发症：动脉渗漏（HR = 1.80[1.45 - 2.24]）、假性动脉瘤（HR = 1.22[1.06 - 1.40]）和假性囊肿（HR = 1.41[1.21 - 1.64]）与开始监测后30天内干预需求增加独立相关。
我们的研究表明，接受非手术治疗的患者中，超过四分之一的患者在第30天时需要进行栓塞或脾切除术。动脉渗漏、假性动脉瘤、假性囊肿以及OIS 4级或5级是与干预需求相关的独立风险因素。
clinicaltrials.gov标识符NCT02021396。
