Age Does Not Affect Outcomes of Nonoperative Management of Blunt Splenic Trauma

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• 作者：Indermeet S. Bhullar ; MD ; FACS^a ; ^{Indermeet.bhullar@jax.ufl.edu} ; Eric R. Frykberg ; MD ; FACS^a ; Daniel Siragusa ; MD^b ; David Chesire ; PhD^a ; Julia Paul ; MSN^a ; Joseph J. Tepas III ; MD ; FACS^c ; Andrew J. Kerwin ; MD ; FACS^a
• 关键词：AE ; angioembolization ; BST ; blunt splenic trauma ; EAST ; Eastern Association for the Surgery of Trauma ; FNOM ; failure of nonoperative management ; NO-AE ; no angioembolization ; NOM ; nonoperative management ; PMSAE ; proximal main splenic artery embolization ; S
• 刊名：Journal of the American College of Surgeons
• 出版年：2012
• 期刊代码：175_10727515
• 类别：med
• 出版时间：June, 2012
• 卷：214
• 期：6
• 页码：958-964
• 文件大小：489 K

摘要

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Background

The purpose of this study was to examine the effect of age on the outcomes of nonoperative management (NOM) of blunt splenic trauma (BST).

Study Design

The records of patients with BST, from July 2000 to December 2010 at a level I trauma center, were retrospectively reviewed using NTRACS (National Trauma Registry of the American College of Surgeons). Patients were divided into 2 age groups: 17 to 55 years and greater than 55 years. Stepwise logistic regression analysis was used to identify risk factors associated with failure of nonoperative management (FNOM).

Results

There were 539 hemodynamically stable patients with BST who underwent NOM. Of these, 459 were age 55 or less, and 80 were greater than 55. Overall, there was no significant difference in FNOM rate for patients age 55 or less vs greater than 55 (4%vs 5%, p = 0.73). This also held true when FNOM was analyzed by each grade: I (1%vs 3%, p = 0.38), II (2%vs 0%, p = 1.0), III (4%vs 0%, p = 1.0), IV (8%vs 20%, p = 0.33), and V (21%vs 50%, p = 0.47). The addition of angioembolization (AE) to high grade IV to V injuries significantly lowered the FNOM rate: age 55 or less (6%AE vs 28%NO-AE, p = 0.02); with a trend toward significance for age greater than 55 (0%AE vs 60%NO-AE, p = 0.2). Age was not a statistically significant independent risk factor for FNOM (p = 0.37).

Conclusions

Age does not affect outcomes of NOM of BST. High grade (IV to V) injuries are not a contraindication to NOM for patients older than 55. As experience with AE grows in patients with high grade injury and age greater than 55, it may prove to be a valuable adjunct to NOM in this group of patients.