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Quantity of hemoperitoneum is associated with need for intervention in patients with stable blunt splenic injury
  1. Kristin Salottolo1,2,3,4,5,6,
  2. Robert M Madayag2,
  3. Michael O'Brien3,
  4. James Yon1,
  5. Allen Tanner3,
  6. Andrew Topham4,
  7. Mark Lieser5,
  8. Matthew M Carrick6,
  9. Charles W Mains2,
  10. David Bar-Or1,2,3,4,5,6
  1. 1Trauma Research, Swedish Medical Center, Englewood, Colorado, USA
  2. 2St. Anthony Hospital, Lakewood, Colorado, USA
  3. 3Penrose-St. Francis Health Services, Colorado Springs, Colorado, USA
  4. 4Radiology, Wesley Medical Center Trauma Services, Wichita, Kansas, USA
  5. 5Trauma Services, Research Medical Center, Kansas City, Missouri, USA
  6. 6Medical Center of Plano, Plano, Texas, USA
  1. Correspondence to Dr David Bar-Or; davidbme49{at}gmail.com

Abstract

Background In patients with hemodynamically stable blunt splenic injury (BSI), there is no consensus on whether quantity of hemoperitoneum (HP) is a predictor for intervention with splenic artery embolization (SAE) or failing nonoperative management (fNOM). We sought to analyze whether the quantity of HP was associated with need for intervention.

Methods This retrospective cohort study included adult trauma patients with hemodynamically stable BSI admitted to six trauma centers between 2014 and 2016. Quantity of HP was defined as small (perisplenic blood or blood in Morrison’s pouch), moderate (blood in one or both pericolic gutters), or large (additional finding of free blood in the pelvis). Multivariate logistic regression was performed to identify predictors of intervention with SAE or fNOM versus successful observation.

Results There were 360 patients: hemoperitoneum was noted in 214 (59%) patients, of which the quantity was small in 92 (43%), moderate in 76 (35.5%), and large in 46 (21.5%). Definitive management was as follows: 272 (76%) were observed and 88 (24%) had intervention (83 SAE, 5 fNOM). The rate of intervention was univariately associated with quantity of HP, even after stratification by American Association for the Surgery of Trauma (AAST) grade. After adjustment, larger quantities of HP significantly increased odds of intervention (p=0.01). Compared with no HP, the odds of intervention were significantly increased for moderate HP (OR=3.51 (1.49 to 8.26)) and large HP (OR=2.89 (1.03 to 8.06)), with similar odds for small HP (OR=1.21 (0.46 to 2.76)). Other independent predictors of intervention were higher AAST grade, older age, and presence of splenic vascular injury.

Conclusion Greater quantity of HP was associated with increased odds of intervention, with no difference in risk for moderate versus large HP. These findings suggest quantity of HP should be incorporated in the management algorithm of BSI as a consideration for angiography and/or embolization to maximize splenic preservation and reduce the risk of splenic rupture.

Level of evidence III, retrospective epidemiological study.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors All authors made substantial contributions to the article as follows: KS is responsible for data analysis, interpretation of data, and drafting the article. MO is responsible for literature search, data acquisition, and revising the article. RMM is responsible for study conception, interpretation of the data, and critical revisions. DB-O, JY, AT, AT, ML, MMC, and CWM are responsible for interpretation of the data and critical revisions. All authors provided final approval of the submitted article.

  • Funding The study was investigator initiated. Internal funding provided by Swedish Medical Center, St. Anthony Hospital, Medical City Plano, Penrose-St. Francis Medical Center; Wesley Medical Center, and Research Medical Center Kansas City.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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