AI Article Synopsis
- The study investigates how the level of trauma center designation affects the management of blunt splenic injuries, shifting from surgical to non-operative approaches.
- A retrospective analysis included 181 patients from two Italian trauma centers, revealing that level 1 centers had a lower rate of splenectomies for high-grade injuries compared to level 2 centers.
- Factors such as systolic pressure and spleen organ injury scale proved significant for non-operative management success, indicating differences in patient treatment and outcomes between the trauma center levels.
Article Abstract
Introduction: The management of blunt splenic trauma has evolved in the last years, from mainly operative approach to the non-operative management (NOM). The aim of this study is to investigate whether trauma center (TC) designation (level 1 and level 2) affects blunt splenic trauma management.
Methods: A retrospective analysis of blunt trauma patients with splenic injury admitted to 2 Italian TCs, Niguarda (level 1) and San Carlo Borromeo (level 2), was performed, receiving either NOM or emergency surgical treatment, from January 1, 2015 to December 31, 2020. Univariate comparison was performed between the two centers, and multivariate analysis was carried out to find predictive factors associated with NOM and splenectomy.
Results: 181 patients were included in the study, 134 from level 1 and 47 from level 2 TCs. The splenectomy/emergency laparotomy ratio was inferior at level 1 TC for high-grade splenic injuries (30.8% for level 1 and 100% for level 2), whose patients presented higher incidence of other injuries. Splenic NOM failure was registered in only one case (3.3%). At multivariate analysis, systolic pressure, spleen organ injury scale (OIS) and injury severity score (ISS) resulted significant predictive factors for NOM, and only spleen OIS was predictive factor for splenectomy (Odds Ratio 0.14, 0.04-0.49 CI 95%, P < .01).
Conclusion: Both level 1 and 2 trauma centers demonstrated application of NOM with a high rate of success with some management difference in the treatment and outcome of patients with splenic injuries between the two types of TCs.
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| http://dx.doi.org/10.1016/j.cireng.2022.07.012 | DOI Listing |
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