Management of Blunt Hepatic and Splenic Trauma in a Greek Level I Trauma Centre
H. Markogiannakis*,**, E. Sanidas*, E. Messaris**, I. Michalakis*, G. Kasotakis*, J. Melissas*, D. Tsiftsis*
*Department of Surgical Oncology, Herakleion University Hospital, Herakleion Medical School, University of Crete, Herakleion, Crete, Greece ; **First Department of Propaedeutic Surgery, Hippocration Hospital, Athens Medical School, University of Athens, Athens, Greece.
Keywords. Blunt abdominal trauma ; liver injury ; splenic injury ; non-operative management ; ICISS ; injury grade.
Abstract. Background and purposes : Non-operative management (NOM) has revolutionized the care of blunt hepatic and splenic trauma patients. The objective of this study is to evaluate treatment of such patients in a Greek level I trauma centre, to identify factors that are important for selecting them for NOM and to investigate for predictors of NOM failure.
Material and methods : We reviewed the Trauma Registry data of 96 consecutive adult patients admitted with blunt liver and/or splenic injuries over a 4-year period.
Results : Immediately operated patients (32.3%) had lower diastolic arterial pressure (p = 0.02), lower International Classification of Diseases –9th revision Injury Severity Score (ICISS) (p = 0.01), and a higher grade of splenic injury (p = 0.002) than NOM patients. NOM success rate was 80%. No predictors of NOM failure were found ; however, isolated splenic trauma patients failed NOM more frequently than hepatic patients (p = 0.02).
Conclusions : NOM of adult blunt hepatic and splenic trauma patients is safe and efficient. Haemodynamic stability, ICISS and the grade of splenic injury are important for selecting these patients for NOM while splenic trauma patients need more intense observation.
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