Blunt hepatic and splenic trauma A single Center experience using a multidisciplinary protocol

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COD: 02_2017_06_2648 Categorie: ,

Paolo Ruscelli, Farncesco Buccoliero, Susanna Mazzocato, Giulio Belfiori, Claudio Rabuini, Pierluigi Sperti, Massimiliano Rimini

Ann. Ital. Chir., 2017 88, 2: 129-136

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AIM: The aim of this retrospective study was to describe more than 10 years experience of a single Trauma Center about
non operative management of abdominal organ injuries in hemodynamically stable patients
MATERIAL OF STUDY: Between January 2001 and December 2014 ,732 consecutive patients were admitted with blunt
abdominal trauma, involving liver and/or spleen and/or kidney, at the Bufalini Cesena Hospital .Management of patients
included a specific institutional developed protocol :hemodynamic stability was evaluated in shock room according to the
patients response to fluid challenge and the patients were classified into three categories A,B,and C.
RESULTS: Form 732 Trauma, 356(48.6%) of patients were submitted to a surgical procedure, all the other patient
376(51.4%) underwent an non operative management .Overall mortality was 9.8% (72), mortality in the surgery group
was 15.4% eheras in the non operative group was 4.5%; the relative risk of mortality, measured by the odds ratio
waith a 95% confidence interval, was 3.417(2.023-5.772) for rhe surgery group; patient over 40 years old has a statistically
significant higher mortality.
DISCUSSION: In our series the overall mortality rate of non operative management group was 4.5%, instead in unstable
patients, the surgery group, the mortality was 15.3%; the overall mortality mortality rate after the application of our
protocol is 9.8%, Although surgery continues to be the standard for hemodically unstable patients with blunt hepatic
and splenic trauma. In our experience AAST Organ Injury Scale was useless for the therapeutic decision making process
after the CT scan if a source of bleeding was detected and immediate angiography was performed in order to control
and solve it.
CONCLUSIONS: In our experience the AAST Organ Injury Scale was useless for the therapeutic decision making process,
The results suggest that the only criteria of choice for therapeutici strategy was the hemodynamic stability, Nonoperative
managem,ent can be applied only following strict institutional criteria.