AI Article Synopsis
- The study aimed to identify factors that predict treatment failure in adult patients with blunt splenic injuries managed non-surgically.
- NST failure occurred in 19.6% of patients, primarily due to abdominal pain, hemodynamic instability, and other complications, with higher failure rates associated with more severe injury grades.
- Key findings indicated that patients with lower Injury Severity Scores (ISS) had a lower failure rate, while those with higher ISS showed a significantly increased risk, suggesting that injury severity is a key prognostic factor.
Article Abstract
Objective: Identify prognostic factors related to treatment failure of blunt splenic injuries managed by non surgical treatment (NST).
Methods: Fifty six adult patients submitted to NST were prospectively studied. The injuries were diagnosed by computed axial tomography scan and classified according to AAST (American Association for Surgery of Trauma) criteria. Patients were divided in success and failure groups. NST failure was defined as the need for laparotomy for any reason.
Results: NST failures (19.6%) were due to: abdominal pain (45.4%), hemodinamic instability (36.4%), splenic haematoma associated to a fall in hematocrit (9.1%) and splenic abscess (9.1%). There were no failures in grade I and II of the splenic injuries; failure rate was 17.5% in grade III and IV injuries grouped, and 80% in grade V injuries (p = 0,0008). In the success group, 31.3% patients received red cell transfusions, versus 63.6% patients in the failure group (p = 0,05). Failure rate in patients with ISS = 8 was zero; 15.9% in patients with ISS 9 to 25; and 50% in patients with ISS = 26 (p = 0,05). There were no deaths or missed bowel injuries.
Conclusion: ISS and splenic injury grade were related to failure of NST.
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| http://dx.doi.org/10.1590/s0100-69912009000200006 | DOI Listing |
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