[Prognostic factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma].
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.
Carvalho
Fábio Henrique de
FH
Clínica Cirúrgica, Universidade Federal do Paraná, BR. fabiohc@uol.com.br
Romeiro
Paula Christina Marra
PC
Collaço
Iwan Augusto
IA
Baretta
Giorgio Alfredo Pedroso
GA
Freitas
Alexandre Coutinho Teixeira de
AC
Matias
Jorge Eduardo Fouto
JE
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