title: [Prognostic factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma].
abstract: OBJECTIVE
  Identify prognostic factors related to treatment failure of blunt splenic injuries managed by non surgical treatment (NST).
  
  
  METHODS
  Fifty six adult patients submitted to NST were prospectively studied. The injuries were diagnosed by computed axial tomography scan and classified according to AAST (American Association for Surgery of Trauma) criteria. Patients were divided in success and failure groups. NST failure was defined as the need for laparotomy for any reason.
  
  
  RESULTS
  NST failures (19.6%) were due to: abdominal pain (45.4%), hemodinamic instability (36.4%), splenic haematoma associated to a fall in hematocrit (9.1%) and splenic abscess (9.1%). There were no failures in grade I and II of the splenic injuries; failure rate was 17.5% in grade III and IV injuries grouped, and 80% in grade V injuries (p = 0,0008). In the success group, 31.3% patients received red cell transfusions, versus 63.6% patients in the failure group (p = 0,05). Failure rate in patients with ISS = 8 was zero; 15.9% in patients with ISS 9 to 25; and 50% in patients with ISS = 26 (p = 0,05). There were no deaths or missed bowel injuries.
  
  
  CONCLUSIONS
  ISS and splenic injury grade were related to failure of NST.
authors.affiliation: Clínica Cirúrgica, Universidade Federal do Paraná, BR. fabiohc@uol.com.br
authors.forename: Fábio Henrique de
authors.initials: FH
authors.lastname: Carvalho
authors.forename: Paula Christina Marra
authors.initials: PC
authors.lastname: Romeiro
authors.forename: Iwan Augusto
authors.initials: IA
authors.lastname: Collaço
authors.forename: Giorgio Alfredo Pedroso
authors.initials: GA
authors.lastname: Baretta
authors.forename: Alexandre Coutinho Teixeira de
authors.initials: AC
authors.lastname: Freitas
authors.forename: Jorge Eduardo Fouto
authors.initials: JE
authors.lastname: Matias
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013154:Spleen / Q000293:injuries*; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000628:therapy*; D055815:Young Adult