背景:钝性肝和/或脾外伤非手术治疗(NOM)期间出现的并发症,特别是在严重受伤的情况下,与显著的发病率和死亡率相关。腹部计算机断层扫描(CT)是NOM期间初始检测并发症的金标准。尽管许多机构提倡常规的院内随访扫描以提高成功率,其他人建议采取更具选择性的方法。后续CT的使用仍然是一个持续辩论的主题,没有关于时间的有效指南,有效性,或随访成像的间隔。
目的:我们的目的是确定临床参数,用于早期发现NOM的钝性肝和/或脾损伤患者的并发症。
方法:这项回顾性队列研究包括在宋卡兰加林德医院治疗的钝性肝和/或脾外伤患者,一级创伤中心,从2013年到2022年。我们评估了所有需要非手术治疗的患者,并检查了他们的临床参数和并发症。
结果:在542例钝性肝和/或脾损伤患者中,315(58%)进行了非手术管理。高度肝损伤与并发症显著相关,如通过多变量逻辑回归分析确定的,在调整了对比脸红结果等因素后,年龄,性别,和损伤严重度评分(ISS)(校正OR=7.69,95%CI1.59-37.13;p=0.011)。在有并发症的患者中(n=27),17人(63%)成功接受了非手术治疗。值得注意的是,八名患者在诊断并发症之前出现临床症状,而只有两名患者在确诊前没有临床症状。心动过速,腹痛,血细胞比容水平降低,和发热是并发症的显著指标(p<0.05)。
结论:对于无症状的低度钝性肝损伤患者,常规CT检查并发症可能是不必要的。相比之下,在那些孤立的钝性肝损伤非手术管理,高级别伤害,在初始成像时存在对比脸红,患者的年龄可能需要考虑常规随访CT扫描。NOM期间的临床症状和实验室观察,比如心动过速,腹痛,血细胞比容水平降低,发烧,与并发症显著相关。这些症状需要进一步治疗,不管最初的伤害严重程度,在接受NOM的钝性肝和/或脾损伤患者中。
BACKGROUND: Complications arising during non-operative management (NOM) of blunt hepatic and/or splenic trauma, particularly in cases of severe injury, are associated with significant morbidity and mortality. Abdominal computed tomography (CT) is the gold standard for the initial detection of complications during NOM. Although many institutions advocate routine in-hospital follow-up scans to improve success rates, others recommend a more selective approach. The use of follow-up CT remains a subject of ongoing debate, with no validated guidelines available regarding the timing, effectiveness, or intervals of follow-up imaging.
OBJECTIVE: We aimed to identify the clinical parameters for the early detection of complications in patients with blunt hepatic and/or splenic injury undergoing NOM.
METHODS: This retrospective cohort study included patients with blunt hepatic and/or splenic trauma treated at Songklanagarind Hospital, a level 1 trauma center, from 2013 to 2022. We assessed all patients indicated for non-operative management and examined their clinical parameters and complications.
RESULTS: Of 542 patients with blunt hepatic and/or splenic injuries, 315 (58%) were managed non-operatively. High-grade hepatic injuries were significantly associated with complications, as determined through a multivariate logistic regression analysis after adjusting for factors such as contrast blush findings, age, sex, and injury severity score (ISS) (adjusted OR = 7.69, 95% CI 1.59-37.13; p = 0.011). Among the patients with complications (n = 27), 17 (63%) successfully underwent non-operative management. Notably, eight patients presented with clinical symptoms prior to the diagnosis of complications, while only two patients had no clinical symptoms before the diagnosis. Tachycardia, abdominal pain, decreased hematocrit levels, and fever were significant indicators of complications (p < 0.05).
CONCLUSIONS: Routine CT to detect complications may not be necessary in patients with asymptomatic low-grade blunt hepatic injuries. By contrast, in those with isolated blunt hepatic injuries that are managed non-operatively, high-grade injuries, the presence of a contrast blush on initial imaging, and the patient\'s age may warrant consideration for routine follow-up CT scans. Clinical symptoms and laboratory observations during NOM, such as tachycardia, abdominal pain, decreased hematocrit levels, and fever, are significantly associated with complications. These symptoms necessitate further management, regardless of the initial injury severity, in patients with blunt hepatic and/or splenic injuries undergoing NOM.