DOI: http://dx.doi.org/10.18203/2349-2902.isj20195128

Outcomes in splenic injury at a high volume tertiary care centre

Amandeep S. Nar, Harpreet S. Lubana, Harmandeep S. Jabbal, Ravinderpal Singh, Atul Mishra, Chamanjot S. Birring

Abstract


Background: The objective of the present study was to study the outcomes of patients following splenic injury at a tertiary care centre.

Methods: This prospective study was conducted over a period of 2 years, from January 2017 to December 2018, at Dayanand Medical College and Hospital, Ludhiana to include all patients presenting to the emergency department with splenic injury diagnosed on focused abdominal sonography in trauma (FAST)/contrast enhanced computed tomography (CECT) abdomen. 60 cases were studied over this time-period. After thorough a work-up, patients were either managed conservatively or by surgical intervention. The results were recorded in a predesigned proforma and the statistics were analyzed to determine the outcome of splenic injury patients at DMCH, Ludhiana.

Results: Among 10% of cases were Grade-V (American Association for Surgery in Trauma (AAST) grading), all of whom required surgical intervention. 3.3% of cases with lesser grade of injury required surgical intervention due to other reasons. 86.7% were managed conservatively. Mean length of stay was 10.9 days. 83.4% of cases were discharged in stable condition with 13.3% cases being discharged against medical advice and a mortality rate of 3.3%.

Conclusions: Majority of patients (86.7%) with splenic injury can be managed conservatively. Surgical intervention is only indicated in patients with Grade-V AAST injury (10%) or in patients with concomitant injury to other organs requiring laparotomy (3.3%). In essence, early diagnosis with FAST and CECT abdomen is the cornerstone in the management of splenic injury, which can help trauma surgeons establish an early management protocol for the better outcome of patients with splenic injury. However, a study with greater sample size is required to further establish the principles of management of splenic trauma in this region.


Keywords


Abdomen, Exploratory laparotomy, American association for surgery in trauma, Contrast-enhanced computed tomography

Full Text:

PDF

References


Miniño AM, Heron MP, Murphy SL, Kochanek KD. Deaths: final data for 2004. Natl Vital Stat Rep. 2007;55:1-119.

Hofman K, Primack A, Keusch G, Hrynkow S. Addressing the growing burden of trauma and injury in low-and middle-income countries. Am J Pub health. 2005;95(1):13-7.

Sabzghabaei A, Shojaee M, Safari S, Hatamabadi HR, Shirvani R. The accuracy of urinalysis in predicting intra-abdominal injury following blunt traumas. Emerg. 2016;4(1):11.

Chardoli M, Rahimi-Movaghar V. Analysis of trauma outcome at a university hospital in Zahedan, Iran using the TRISS method. East Afr Medi J. 2006;83(8):440-2.

Shojaee M, Dolatabadi AA, Sabzghabaei A, Malekirastekenari A, Faridaalaee G, Yousefifard M, et al. New scoring system for intra-abdominal injury diagnosis after blunt trauma. Chin J Traumatol. 2014;17(1):19-24.

Brady RR, Bandari M, Kerssens JJ, Paterson-Brown S, Parks RW. Splenic trauma in Scotland: demographics and outcomes. World J Surg. 2007;31(11):2111-6.

Advanced Trauma Life Support® Manual. 8th ed. 2010.

Van der Vlies CH, Van Delden OM, Punt BJ, Ponsen KJ, Reekers JA, Goslings JC. Literature review of the role of ultrasound, computed tomography, and transcatheter arterial embolization for the treatment of traumatic splenic injuries. Cardio Int Radiol. 2010;33(6):1079-87.

Brown CK, Dunn KA, Wilson K. Diagnostic evaluation of patients with blunt abdominal trauma: a decision analysis. Acad Emerg Med. 2000;7(4):385-96.

Schiffman MA. Nonoperative management of blunt abdominal trauma in pediatrics. Emerg Med Clin North Am. 1989;7(3):519-35.

Savage SA, Zarzaur BL, Magnotti LJ, Weinberg JA, Maish GO, Bee TK, et al. The evolution of blunt splenic injury: resolution and progression. J Trauma Acute Care Surg. 2008;64(4):1085-92.

Cirocchi R, Corsi A, Castellani E, Barberini F, Renzi C, Cagini L, et al. Case series of non-operative management vs. operative management of splenic injury after blunt trauma. Ulus Travma Acil Cerrahi Derg. 2014;20(2):91-6.

Pitcher ME, And RC, Mackay JR. Splenectomy for trauma: morbidity, mortality and associated abdominal injuries. Aust New Zeal J Surg. 1989;59(6):461-3.