[논문]Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management

Na, Joung Won; Lee, Jung Nam; Yu, Byung Chul; Lee, Min A; Park, Jae Jung; Lee, Gil Jae

doi:10.20408/jti.2017.30.3.91

Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management 원문보기

Journal of trauma and injury : JTI, v.30 no.3, 2017년, pp.91 - 97

Na, Joung Won (Department of Surgery, Gachon University Gil Medical Center) , Lee, Jung Nam (Gachon University Gil Hospital Trauma Center) , Yu, Byung Chul (Gachon University Gil Hospital Trauma Center) , Lee, Min A (Gachon University Gil Hospital Trauma Center) , Park, Jae Jung (Gachon University Gil Hospital Trauma Center) , Lee, Gil Jae (Gachon University Gil Hospital Trauma Center)

Abstract ▼ AI-Helper

Purpose: Purpose: The prognostic factors of non-operative management (NOM) in high-grade spleen injuries have been extensively studied, but factors that would help treatment decisions are lacking. We compared the characteristics of the patients to identify the factors affecting treatment choices. Methods: This is a review of 207 blunt spleen injury patients from January 2004 to December 2013. We compared clinical features and mortality between surgery and NOM, and used multivariate regression analysis to find the factor most strongly associated with prognosis. Results: Of the 207 patients, 107 had high-grade spleen injury patents (grade III or above). Of these, 42 patients underwent surgery and 65 patients underwent NOM. The mortality was 7% following surgery, 3% with NOM. The amount of packed red blood cells transfused in the first 24 hours and spleen injury grade were associated with management type, and mortality was highly associated with activated partial thromboplastin time (aPTT) and spleen injury grade. Conclusions: The grade of spleen injury was associated with management and mortality, so correctly assessing the spleen injury grade is important.

주제어

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문제 정의

The object of this study is to review 10 years of experience of treatment for blunt spleen injury and identify predictive factors.

제안 방법

In our study, the factors affecting treatment and prognosis of blunt spleen injury were age, injury mechanism, spleen injury grade, initial vital status, CBC, coagulation battery, and the amount of transfusion in first 24 hours. These variables were compared by treatment type (NOM or SP), followed by bivariate regression analysis of the factors that were significantly different.

대상 데이터

During the study period, 247 patients were hospitalized and among them, patients under 15 years of age were excluded. Children tend to have a slight degree of injury compared to adults at the same trauma.
Our study was a retrospective study using medical records of 247 patients admitted to a university hospital between January 2004 and December 2013 for blunt spleen injury who had contrast enhanced computed tomography scans and confirmed spleen injuries. We excluded patients under 15 years old.
Our study had considerable limitations. The patient records of this study included 10 years of data before establishment of the trauma center in this hospital, so there could be many omissions. The study sample size was small.

데이터처리

Initial status, clinical features and mortality of the patients and their values were compared by the management types (surgical patients [SP] and NOM). Among these, categorical variables were expressed using chi-square analysis, and continuous items we are compared using independent sample t-test. We used bivariate regression analysis to assess factors associated with mortality and management type as the odds ratio [11].

이론/모형

We compared patient characteristics (age, sex, injury mechanism), AIS, ISS, and spleen injury grade. Spleen injury grading follows the American Association for the Surgery of Trauma (AAST) Splenic Injury Scale [6-8] (Table 1).

성능/효과

In conclusion, mortality of high grade spleen injury patients was higher than low grade injuries, and mortality of NOM patients was lower than in surgically managed patients. The factors that affect the treatment options in high grade splenic injury were aPTT and spleen injury grade.
The results showed that the NOM patients’ values were closer to normal than the SP patients.

참고문헌 (25)

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Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management 원문보기

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Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management 원문보기

Abstract ▼ AI-Helper

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