Criteria for nonoperative management of blunt splenic trauma

"nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and di...

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Main Authors: Sarmast Shoushtary MH, Askarpour Sh, Asgari M, Talaiezadeh A, Sabet M
Format: Article
Language:fas
Published: Tehran University of Medical Sciences 2009-02-01
Series:Tehran University Medical Journal
Subjects:
Online Access:http://journals.tums.ac.ir/PdfMed.aspx?pdf_med=/upload_files/pdf/13227.pdf&manuscript_id=13227
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spelling doaj-9262f64287fd4074bdbbccc79fcdd1652020-11-25T00:19:13ZfasTehran University of Medical SciencesTehran University Medical Journal1683-17641735-73222009-02-016611835842Criteria for nonoperative management of blunt splenic traumaSarmast Shoushtary MHAskarpour ShAsgari MTalaiezadeh ASabet M"nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery. "nMethods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS) scoring system, CT scan findings, amount of blood transfusion; Hospitalization time and mechanism of injury were recorded. "nResults: From 101 patients, 61(60.3%) underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7%) nonoperative management was successful. In 10 patients (9.9%) This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings. "nConclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.http://journals.tums.ac.ir/PdfMed.aspx?pdf_med=/upload_files/pdf/13227.pdf&manuscript_id=13227Abdominal trauma bluntsplenic injurymanagement nonoperative
collection DOAJ
language fas
format Article
sources DOAJ
author Sarmast Shoushtary MH
Askarpour Sh
Asgari M
Talaiezadeh A
Sabet M
spellingShingle Sarmast Shoushtary MH
Askarpour Sh
Asgari M
Talaiezadeh A
Sabet M
Criteria for nonoperative management of blunt splenic trauma
Tehran University Medical Journal
Abdominal trauma blunt
splenic injury
management nonoperative
author_facet Sarmast Shoushtary MH
Askarpour Sh
Asgari M
Talaiezadeh A
Sabet M
author_sort Sarmast Shoushtary MH
title Criteria for nonoperative management of blunt splenic trauma
title_short Criteria for nonoperative management of blunt splenic trauma
title_full Criteria for nonoperative management of blunt splenic trauma
title_fullStr Criteria for nonoperative management of blunt splenic trauma
title_full_unstemmed Criteria for nonoperative management of blunt splenic trauma
title_sort criteria for nonoperative management of blunt splenic trauma
publisher Tehran University of Medical Sciences
series Tehran University Medical Journal
issn 1683-1764
1735-7322
publishDate 2009-02-01
description "nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery. "nMethods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS) scoring system, CT scan findings, amount of blood transfusion; Hospitalization time and mechanism of injury were recorded. "nResults: From 101 patients, 61(60.3%) underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7%) nonoperative management was successful. In 10 patients (9.9%) This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings. "nConclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.
topic Abdominal trauma blunt
splenic injury
management nonoperative
url http://journals.tums.ac.ir/PdfMed.aspx?pdf_med=/upload_files/pdf/13227.pdf&manuscript_id=13227
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