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Titolo:
Nonoperative management of blunt splenic injury in adults 55 years and older: A twenty-year experience
Autore:
Krause, KR; Howells, GA; Bair, HA; Glover, JL; Madrazo, BL; Wasvary, HJ; Bendick, PJ;
Indirizzi:
William Beaumont Hosp, Div Trauma Surg, Royal Oak, MI 48073 USA William Beaumont Hosp Royal Oak MI USA 48073 urg, Royal Oak, MI 48073 USA William Beaumont Hosp, Dept Surg, Royal Oak, MI 48073 USA William BeaumontHosp Royal Oak MI USA 48073 urg, Royal Oak, MI 48073 USA William Beaumont Hosp, Dept Radiol, Royal Oak, MI 48073 USA William Beaumont Hosp Royal Oak MI USA 48073 iol, Royal Oak, MI 48073 USA
Titolo Testata:
AMERICAN SURGEON
fascicolo: 7, volume: 66, anno: 2000,
pagine: 636 - 640
SICI:
0003-1348(200007)66:7<636:NMOBSI>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
RUPTURED SPLEEN; NONSURGICAL MANAGEMENT; COMPUTED-TOMOGRAPHY; EARLY OPERATION; TRAUMA; CRITERIA; FAILURE; LIVER; AGE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Howells, GA William Beaumont Hosp, Div Trauma Surg, 3601 W 13 Mile Rd, Royal Oak, MI 48073 USA William Beaumont Hosp 3601 W 13 Mile Rd Royal Oak MI USA 48073
Citazione:
K.R. Krause et al., "Nonoperative management of blunt splenic injury in adults 55 years and older: A twenty-year experience", AM SURG, 66(7), 2000, pp. 636-640

Abstract

The nonoperative management of splenic injury secondary to blunt trauma inolder patients remains controversial. We have reviewed our experience fromJanuary 1978 to December 1997 with selective nonoperative management of blunt splenic injury in adults 55 years and older. Criteria for nonoperative management included hemodynamic stability with any transient hypotension corrected using less than 2000 cm(3) crystalloid infusion, a negative abdominal physical examination ruling out associated injuries, and a blood transfusion requirement of no more than 2 units attributable to the splenic injury. During the study period, 18 patients over age 55 with radiographic confirmation of a splenic injury met the above criteria for nonoperative management. Their mean age was 72 years (range 56-86), and 13 of the 18 were female(72%). The mean Injury Severity Score was 15 (range 4-29), with the mechanism of injury equally divided between automobile crashes (9) and falls (9). During a similar time period, 15 patients 55 years or older with splenic injury composed an operative group; these patients did not differ with respect to age (mean 68 years), sex (60% female), or mechanism of injury. CT scans of 8 patients managed nonoperatively were available and graded using theAmerican Association for the Surgery of Trauma classification, with a meanscore of 2.3 (range 2-3). Eight of the 18 nonsurgical patients received blood transfusions. None of the 18 patients who met the criteria for nonoperative management "failed" the protocol, and none were taken to the operatingroom for abdominal exploration. Two patients (11%) died of associated thoracic injuries after lengthy hospital stays, one at 10 days and one at 24 days. We conclude from our data that nonoperative management of blunt splenicinjury in patients age 55 years and older is indicated provided they are hemodynamically stable, do not require significant blood transfusion, and have no other associated abdominal injuries.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/09/20 alle ore 09:11:49