Comparison between level 1 and level 2 trauma centers for the management of splenic blunt trauma |
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| Affiliation: | 1. Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy;2. Department of Biomedical Sciences for Health, University of Milan, Italy;3. General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy;1. General and Digestive Surgery Service: Hospital Universitario Son Espases, Palma de Mallorca, Spain;2. Faculty of Medicine, Universidad de las Islas Baleares, Palma de Mallorca, Spain;3. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain;1. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Jiménez Díaz, Madrid, España;2. Servicio de Urología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España;1. Breast Cancer Unit, Obstetrics and Gynecology, Women’s Health Institute, Clíníco San Carlos Hospital, Madrid, Spain;2. Clinical Trials and Research Unit, IdISSC, Health Department, International University of La Rioja, La Rioja, Spain;3. Breast Cancer Unit, Psychology, Women’s Health Institute, Clíníco San Carlos Hospital, Madrid, Spain |
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| Abstract: | IntroductionThe management of blunt splenic trauma has evolved in the last years, from mainly operative approach to the non-operative management (NOM). The aim of this study is to investigate whether trauma center (TC) designation (level 1 and level 2) affects blunt splenic trauma management.MethodsA retrospective analysis of blunt trauma patients with splenic injury admitted to 2 Italian TCs, Niguarda (level 1) and San Carlo Borromeo (level 2), was performed, receiving either NOM or emergency surgical treatment, from January 1, 2015 to December 31, 2020. Univariate comparison was performed between the two centers, and multivariate analysis was carried out to find predictive factors associated with NOM and splenectomy.Results181 patients were included in the study, 134 from level 1 and 47 from level 2 TCs. The splenectomy/emergency laparotomy ratio was inferior at level 1 TC for high-grade splenic injuries (30.8% for level 1 and 100% for level 2), whose patients presented higher incidence of other injuries. Splenic NOM failure was registered in only one case (3.3%). At multivariate analysis, systolic pressure, spleen organ injury scale (OIS) and injury severity score (ISS) resulted significant predictive factors for NOM, and only spleen OIS was predictive factor for splenectomy (Odds Ratio 0.14, 0.04–0.49 CI 95%, P < .01).ConclusionBoth level 1 and 2 trauma centers demonstrated application of NOM with a high rate of success with some management difference in the treatment and outcome of patients with splenic injuries between the two types of TCs. |
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| Keywords: | Spleen Trauma NOM Splenectomy Bazo Trauma NOM Esplenectomía |
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