Recent trends in management strategy and 28-day mortality of blunt splenic injury in Japan: A nationwide trauma database studyChie Tanaka, MD; Takashi Tagami, MD, MPH, PhD; Hisashi Matsumoto, MD, PhD; Kiyoshi Matsuda, MD, PhD; Shiei Kim, MD; Yuta Moroe, M
CCCF ePoster library. Tanaka C. Nov 2, 2016; 150988; 107
Chie Tanaka
Chie Tanaka
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Topic: Retrospective or Prospective Cohort Study

Recent trends in management strategy and 28-day mortality of blunt splenic injury in Japan: A nationwide trauma database studyChie Tanaka, MD; Takashi Tagami, MD, MPH, PhD; Hisashi Matsumoto, MD, PhD; Kiyoshi Matsuda, MD, PhD; Shiei Kim, MD; Yuta Moroe, M


Tanaka Chie1, MD; Tagami Takashi1, MD, MPH, PhD; Matsumoto Hisashi2, MD, PhD; Matsuda Kiyoshi3, MD, PhD; Kim Shiei4, MD;  Moroe Yuta1, MD; Fukuda Reo1, MD;  Unemoto Kyoko1, MD, PhD; Yokota Hiroyuki4, MD, PhD.

1Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan; 2Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba  Hokuso Hospital, Chiba, Japan; 3Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan; 4Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan. 



Abstract:

Background:
Non-operative management (NOM), with or without transcatheter arterial embolization (TAE), has recently become a common initial intervention for hemodynamically stable blunt splenic injury patients. However, limited epidemiological results are available. We aimed to evaluate the current practice and outcome of blunt splenic injury in Japan.
Methods:
Within the 2004-2014 records of the Japan Trauma Data Bank, we retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V). We grouped these records based on the change in splenic injury management guidelines: phase I (2004-2008), phase II (2009-2011), and phase III (2012-2014). We used the Mantel-Haenszel trend test to analyze the time evolution of the prevalence of certain initial interventions and 28-day mortality. We also evaluated the association between the time phase and in-hospital 28-day mortality using a logistic regression model adjusted for within-hospital clustering, age, splenic injury grade, time from hospitalization to initiation of intensive treatment, and management strategy.
Results:
The provision of NOM with or without TAE increased, while that of laparotomy decreased significantly for splenic or multiple injury (p = 0.02 for each). 28-day mortality for laparotomy significantly decreased across the three phases (p = 0.03), however, there were no significant differences regarding that for NOM with or without TAE. Besides, 28-day mortality of whole splenic injury patients decreased significantly (p < 0.01) over time, with odds ratio of 0.48 (95% confidence interval, 0.26-0.87) and 0.34 (95% confidence interval, 0.19-0.61) for the transitions from phase I to II, and I to III, respectively.
Conclusions:
The provision of NOM, with or without TAE, as initial splenic injury management has significantly increased in Japan between 2004 and 2014. In-hospital 28-day mortality of splenic injury significantly decreased, even after adjustment for within-hospital clustering and other factors independently associated with mortality.
 


References:

Eastern Association for the Surgery of Trauma (EAST) Ad Hoc Committee on Practice Management Guideline Development. Non-operative management of blunt injury to the liver and spleen 2003. 2003 [updated 2003; cited 2016 February 14]. Available from: https://www.east.org/content/documents/livspleen.pdf
Moore FA, Davis JW, Moore EE, Jr., Cocanour CS, West MA, McIntyre RC, Jr. Western Trauma Association (WTA) critical decisions in trauma: management of adult blunt splenic trauma. J Trauma. 2008;65:1007-1011.
Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ, Jr., Sangosanya A, et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73:S294-300.
 



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