Failure of nonoperative management of splenic injuries: Causes and consequences

Lisa K. McIntyre, Melissa Schiff, Gregory J. Jurkovich, John Weigelt, Juan A. Asensio, Thomas H. Cogbill, Thomas S. Helling

Research output: Contribution to journalReview article

75 Citations (Scopus)

Abstract

Hypothesis: Presenting patient characteristics can predict which patients will fail nonoperative therapy of blunt splenic injuries. Design: Retrospective descriptive population study. Setting: All patients admitted with blunt splenic trauma were identified from a statewide trauma registry between January 1, 1995, and December 31, 2001. Patients and Methods: Patients were characterized as requiring immediate intervention or successful or failed nonoperative management based on time from emergency department arrival to intervention (surgery or angioembolectomy). Injury and patient characteristics included age, the presence of hypotension, Injury Severity Score, and the Glasgow Coma Scale score. Risk factors for the failure of nonoperative management were evaluated using the χ2 statistic. The failure of nonoperative management associated with the admitting hospital's trauma designation level was evaluated using logistic regression. Interventions: None. Main Outcome Measures: Determine factors associated with failure of nonoperative management of blunt splenic injuries. Results: Two thousand two hundred forty-three patients met criteria for inclusion in the study. Six hundred ten patients (27%) underwent immediate splenectomy, splenorrhaphy, or splenic embolization (within 4 hours). Of the remaining 1633 patients who were admitted with planned nonoperative management, 252 patients (15%) failed. Of the injury and patient characteristics reviewed, being older than 55 years and having an ISS higher than 25 were significantly associated with failure. Risk of failure also increased with admission to a level III or IV trauma hospital compared with a level I trauma hospital. Conclusions: Being older than 55 years and having an ISS higher than 25 along with admission to a level III or IV trauma hospital were associated with a significant risk of failure of nonoperative management of splenic injuries. The Glasgow Coma Scale score, associated injuries, and presenting hemodynamics were not predictive of failure in this large retrospective review.

Original languageEnglish
Pages (from-to)563-569
Number of pages7
JournalArchives of Surgery
Volume140
Issue number6
DOIs
StatePublished - Jun 2005

Fingerprint

Wounds and Injuries
Nonpenetrating Wounds
Glasgow Coma Scale
Injury Severity Score
Splenectomy
Hypotension
Registries
Hospital Emergency Service
Logistic Models
Hemodynamics
Outcome Assessment (Health Care)
Population

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

McIntyre, L. K., Schiff, M., Jurkovich, G. J., Weigelt, J., Asensio, J. A., Cogbill, T. H., & Helling, T. S. (2005). Failure of nonoperative management of splenic injuries: Causes and consequences. Archives of Surgery, 140(6), 563-569. https://doi.org/10.1001/archsurg.140.6.563

Failure of nonoperative management of splenic injuries : Causes and consequences. / McIntyre, Lisa K.; Schiff, Melissa; Jurkovich, Gregory J.; Weigelt, John; Asensio, Juan A.; Cogbill, Thomas H.; Helling, Thomas S.

In: Archives of Surgery, Vol. 140, No. 6, 06.2005, p. 563-569.

Research output: Contribution to journalReview article

McIntyre, LK, Schiff, M, Jurkovich, GJ, Weigelt, J, Asensio, JA, Cogbill, TH & Helling, TS 2005, 'Failure of nonoperative management of splenic injuries: Causes and consequences', Archives of Surgery, vol. 140, no. 6, pp. 563-569. https://doi.org/10.1001/archsurg.140.6.563
McIntyre, Lisa K. ; Schiff, Melissa ; Jurkovich, Gregory J. ; Weigelt, John ; Asensio, Juan A. ; Cogbill, Thomas H. ; Helling, Thomas S. / Failure of nonoperative management of splenic injuries : Causes and consequences. In: Archives of Surgery. 2005 ; Vol. 140, No. 6. pp. 563-569.
@article{d64542cfb0c54b1d8b1851852d384b06,
title = "Failure of nonoperative management of splenic injuries: Causes and consequences",
abstract = "Hypothesis: Presenting patient characteristics can predict which patients will fail nonoperative therapy of blunt splenic injuries. Design: Retrospective descriptive population study. Setting: All patients admitted with blunt splenic trauma were identified from a statewide trauma registry between January 1, 1995, and December 31, 2001. Patients and Methods: Patients were characterized as requiring immediate intervention or successful or failed nonoperative management based on time from emergency department arrival to intervention (surgery or angioembolectomy). Injury and patient characteristics included age, the presence of hypotension, Injury Severity Score, and the Glasgow Coma Scale score. Risk factors for the failure of nonoperative management were evaluated using the χ2 statistic. The failure of nonoperative management associated with the admitting hospital's trauma designation level was evaluated using logistic regression. Interventions: None. Main Outcome Measures: Determine factors associated with failure of nonoperative management of blunt splenic injuries. Results: Two thousand two hundred forty-three patients met criteria for inclusion in the study. Six hundred ten patients (27{\%}) underwent immediate splenectomy, splenorrhaphy, or splenic embolization (within 4 hours). Of the remaining 1633 patients who were admitted with planned nonoperative management, 252 patients (15{\%}) failed. Of the injury and patient characteristics reviewed, being older than 55 years and having an ISS higher than 25 were significantly associated with failure. Risk of failure also increased with admission to a level III or IV trauma hospital compared with a level I trauma hospital. Conclusions: Being older than 55 years and having an ISS higher than 25 along with admission to a level III or IV trauma hospital were associated with a significant risk of failure of nonoperative management of splenic injuries. The Glasgow Coma Scale score, associated injuries, and presenting hemodynamics were not predictive of failure in this large retrospective review.",
author = "McIntyre, {Lisa K.} and Melissa Schiff and Jurkovich, {Gregory J.} and John Weigelt and Asensio, {Juan A.} and Cogbill, {Thomas H.} and Helling, {Thomas S.}",
year = "2005",
month = "6",
doi = "10.1001/archsurg.140.6.563",
language = "English",
volume = "140",
pages = "563--569",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Failure of nonoperative management of splenic injuries

T2 - Causes and consequences

AU - McIntyre, Lisa K.

AU - Schiff, Melissa

AU - Jurkovich, Gregory J.

AU - Weigelt, John

AU - Asensio, Juan A.

AU - Cogbill, Thomas H.

AU - Helling, Thomas S.

PY - 2005/6

Y1 - 2005/6

N2 - Hypothesis: Presenting patient characteristics can predict which patients will fail nonoperative therapy of blunt splenic injuries. Design: Retrospective descriptive population study. Setting: All patients admitted with blunt splenic trauma were identified from a statewide trauma registry between January 1, 1995, and December 31, 2001. Patients and Methods: Patients were characterized as requiring immediate intervention or successful or failed nonoperative management based on time from emergency department arrival to intervention (surgery or angioembolectomy). Injury and patient characteristics included age, the presence of hypotension, Injury Severity Score, and the Glasgow Coma Scale score. Risk factors for the failure of nonoperative management were evaluated using the χ2 statistic. The failure of nonoperative management associated with the admitting hospital's trauma designation level was evaluated using logistic regression. Interventions: None. Main Outcome Measures: Determine factors associated with failure of nonoperative management of blunt splenic injuries. Results: Two thousand two hundred forty-three patients met criteria for inclusion in the study. Six hundred ten patients (27%) underwent immediate splenectomy, splenorrhaphy, or splenic embolization (within 4 hours). Of the remaining 1633 patients who were admitted with planned nonoperative management, 252 patients (15%) failed. Of the injury and patient characteristics reviewed, being older than 55 years and having an ISS higher than 25 were significantly associated with failure. Risk of failure also increased with admission to a level III or IV trauma hospital compared with a level I trauma hospital. Conclusions: Being older than 55 years and having an ISS higher than 25 along with admission to a level III or IV trauma hospital were associated with a significant risk of failure of nonoperative management of splenic injuries. The Glasgow Coma Scale score, associated injuries, and presenting hemodynamics were not predictive of failure in this large retrospective review.

AB - Hypothesis: Presenting patient characteristics can predict which patients will fail nonoperative therapy of blunt splenic injuries. Design: Retrospective descriptive population study. Setting: All patients admitted with blunt splenic trauma were identified from a statewide trauma registry between January 1, 1995, and December 31, 2001. Patients and Methods: Patients were characterized as requiring immediate intervention or successful or failed nonoperative management based on time from emergency department arrival to intervention (surgery or angioembolectomy). Injury and patient characteristics included age, the presence of hypotension, Injury Severity Score, and the Glasgow Coma Scale score. Risk factors for the failure of nonoperative management were evaluated using the χ2 statistic. The failure of nonoperative management associated with the admitting hospital's trauma designation level was evaluated using logistic regression. Interventions: None. Main Outcome Measures: Determine factors associated with failure of nonoperative management of blunt splenic injuries. Results: Two thousand two hundred forty-three patients met criteria for inclusion in the study. Six hundred ten patients (27%) underwent immediate splenectomy, splenorrhaphy, or splenic embolization (within 4 hours). Of the remaining 1633 patients who were admitted with planned nonoperative management, 252 patients (15%) failed. Of the injury and patient characteristics reviewed, being older than 55 years and having an ISS higher than 25 were significantly associated with failure. Risk of failure also increased with admission to a level III or IV trauma hospital compared with a level I trauma hospital. Conclusions: Being older than 55 years and having an ISS higher than 25 along with admission to a level III or IV trauma hospital were associated with a significant risk of failure of nonoperative management of splenic injuries. The Glasgow Coma Scale score, associated injuries, and presenting hemodynamics were not predictive of failure in this large retrospective review.

UR - http://www.scopus.com/inward/record.url?scp=21244444337&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=21244444337&partnerID=8YFLogxK

U2 - 10.1001/archsurg.140.6.563

DO - 10.1001/archsurg.140.6.563

M3 - Review article

C2 - 15967903

AN - SCOPUS:21244444337

VL - 140

SP - 563

EP - 569

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 6

ER -