Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study
Purpose To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. Materials and methods This Institutional Review Board-approved study collected 351 conse...
Gespeichert in:
| Veröffentlicht in: | Emergency radiology 2018-10, Vol.25 (5), p.489-497 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 497 |
|---|---|
| container_issue | 5 |
| container_start_page | 489 |
| container_title | Emergency radiology |
| container_volume | 25 |
| creator | Margari, Sergio Garozzo Velloni, Fernanda Tonolini, Massimo Colombo, Ettore Artioli, Diana Allievi, Niccolò Ettore Sammartano, Fabrizio Chiara, Osvaldo Vanzulli, Angelo |
| description | Purpose
To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma.
Materials and methods
This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student’s
t
, chi-squared, and Cohen’s kappa tests.
Results
Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (
k
= 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (
p
|
| doi_str_mv | 10.1007/s10140-018-1607-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2038273951</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2038273951</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-3272f6421fdd89f9a59e75681ad321bad5f69928ab237c348aacd4c6f5665bf83</originalsourceid><addsrcrecordid>eNp1kU-L2zAQxcXSsv_aD9BLEfTSi7sayZLs3krYdguBvaRnMbZHwcGWU8kuybdfZbNtodDTzDC_92bgMfYOxCcQwt4lEFCKQkBVgBG2OFywayhVnkqlX-VeWFEoIcordpPSTghhalNdsitZWy2Nhmt2uB8pbim0R77acD9FjilRSiOFmWPo-IgBt_Q8Tp43w5KbOeIy4ty3PO0HCrn2YbfEnhLHrOJr-kUDB7555vgqiyl-5qCKI2HkaV664xv22uOQ6O1LvWU_vt5vVg_F-vHb99WXddEqK-dCSSu9KSX4rqtqX6OuyWpTAXZKQoOd9qauZYWNVLZVZYXYdmVrvDZGN75St-zj2Xcfp58LpdmNfWppGDDQtCQnhaqkVbWGjH74B91NSwz5uxNlpQHQOlNwpto4pRTJu33sR4xHB8KdYnHnWFyOxZ1icYesef_ivDQjdX8Uv3PIgDwDKa_CluLf0_93fQL2_pfF</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2037261155</pqid></control><display><type>article</type><title>Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study</title><source>Springer Nature - Complete Springer Journals</source><creator>Margari, Sergio ; Garozzo Velloni, Fernanda ; Tonolini, Massimo ; Colombo, Ettore ; Artioli, Diana ; Allievi, Niccolò Ettore ; Sammartano, Fabrizio ; Chiara, Osvaldo ; Vanzulli, Angelo</creator><creatorcontrib>Margari, Sergio ; Garozzo Velloni, Fernanda ; Tonolini, Massimo ; Colombo, Ettore ; Artioli, Diana ; Allievi, Niccolò Ettore ; Sammartano, Fabrizio ; Chiara, Osvaldo ; Vanzulli, Angelo</creatorcontrib><description>Purpose
To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma.
Materials and methods
This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student’s
t
, chi-squared, and Cohen’s kappa tests.
Results
Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (
k
= 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (
p
< 0.05) predictors of OM. Nonoperative management (NOM) failed in 23 patients out of 191 (12.04%). In 75% of them, NOM failure occurred within 30 h from the trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (
p
< 0.05).
Conclusion
Providing detection and characterization of parenchymal and vascular traumatic lesions, MDCT plays a crucial role for safe and appropriate guidance of ED management of splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.</description><identifier>ISSN: 1070-3004</identifier><identifier>EISSN: 1438-1435</identifier><identifier>DOI: 10.1007/s10140-018-1607-x</identifier><identifier>PMID: 29752651</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Bleeding ; Computed tomography ; Emergency management ; Emergency medical services ; Emergency Medicine ; Imaging ; Information management ; Injuries ; Lesions ; Medicine ; Medicine & Public Health ; Original Article ; Patients ; Radiology ; Statistical analysis ; Statistical tests ; Trauma ; Trauma centers</subject><ispartof>Emergency radiology, 2018-10, Vol.25 (5), p.489-497</ispartof><rights>American Society of Emergency Radiology 2018</rights><rights>Emergency Radiology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-3272f6421fdd89f9a59e75681ad321bad5f69928ab237c348aacd4c6f5665bf83</citedby><cites>FETCH-LOGICAL-c372t-3272f6421fdd89f9a59e75681ad321bad5f69928ab237c348aacd4c6f5665bf83</cites><orcidid>0000-0001-9900-1801</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10140-018-1607-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10140-018-1607-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29752651$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Margari, Sergio</creatorcontrib><creatorcontrib>Garozzo Velloni, Fernanda</creatorcontrib><creatorcontrib>Tonolini, Massimo</creatorcontrib><creatorcontrib>Colombo, Ettore</creatorcontrib><creatorcontrib>Artioli, Diana</creatorcontrib><creatorcontrib>Allievi, Niccolò Ettore</creatorcontrib><creatorcontrib>Sammartano, Fabrizio</creatorcontrib><creatorcontrib>Chiara, Osvaldo</creatorcontrib><creatorcontrib>Vanzulli, Angelo</creatorcontrib><title>Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study</title><title>Emergency radiology</title><addtitle>Emerg Radiol</addtitle><addtitle>Emerg Radiol</addtitle><description>Purpose
To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma.
Materials and methods
This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student’s
t
, chi-squared, and Cohen’s kappa tests.
Results
Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (
k
= 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (
p
< 0.05) predictors of OM. Nonoperative management (NOM) failed in 23 patients out of 191 (12.04%). In 75% of them, NOM failure occurred within 30 h from the trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (
p
< 0.05).
Conclusion
Providing detection and characterization of parenchymal and vascular traumatic lesions, MDCT plays a crucial role for safe and appropriate guidance of ED management of splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.</description><subject>Bleeding</subject><subject>Computed tomography</subject><subject>Emergency management</subject><subject>Emergency medical services</subject><subject>Emergency Medicine</subject><subject>Imaging</subject><subject>Information management</subject><subject>Injuries</subject><subject>Lesions</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Patients</subject><subject>Radiology</subject><subject>Statistical analysis</subject><subject>Statistical tests</subject><subject>Trauma</subject><subject>Trauma centers</subject><issn>1070-3004</issn><issn>1438-1435</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kU-L2zAQxcXSsv_aD9BLEfTSi7sayZLs3krYdguBvaRnMbZHwcGWU8kuybdfZbNtodDTzDC_92bgMfYOxCcQwt4lEFCKQkBVgBG2OFywayhVnkqlX-VeWFEoIcordpPSTghhalNdsitZWy2Nhmt2uB8pbim0R77acD9FjilRSiOFmWPo-IgBt_Q8Tp43w5KbOeIy4ty3PO0HCrn2YbfEnhLHrOJr-kUDB7555vgqiyl-5qCKI2HkaV664xv22uOQ6O1LvWU_vt5vVg_F-vHb99WXddEqK-dCSSu9KSX4rqtqX6OuyWpTAXZKQoOd9qauZYWNVLZVZYXYdmVrvDZGN75St-zj2Xcfp58LpdmNfWppGDDQtCQnhaqkVbWGjH74B91NSwz5uxNlpQHQOlNwpto4pRTJu33sR4xHB8KdYnHnWFyOxZ1icYesef_ivDQjdX8Uv3PIgDwDKa_CluLf0_93fQL2_pfF</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Margari, Sergio</creator><creator>Garozzo Velloni, Fernanda</creator><creator>Tonolini, Massimo</creator><creator>Colombo, Ettore</creator><creator>Artioli, Diana</creator><creator>Allievi, Niccolò Ettore</creator><creator>Sammartano, Fabrizio</creator><creator>Chiara, Osvaldo</creator><creator>Vanzulli, Angelo</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9900-1801</orcidid></search><sort><creationdate>20181001</creationdate><title>Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study</title><author>Margari, Sergio ; Garozzo Velloni, Fernanda ; Tonolini, Massimo ; Colombo, Ettore ; Artioli, Diana ; Allievi, Niccolò Ettore ; Sammartano, Fabrizio ; Chiara, Osvaldo ; Vanzulli, Angelo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-3272f6421fdd89f9a59e75681ad321bad5f69928ab237c348aacd4c6f5665bf83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Bleeding</topic><topic>Computed tomography</topic><topic>Emergency management</topic><topic>Emergency medical services</topic><topic>Emergency Medicine</topic><topic>Imaging</topic><topic>Information management</topic><topic>Injuries</topic><topic>Lesions</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Patients</topic><topic>Radiology</topic><topic>Statistical analysis</topic><topic>Statistical tests</topic><topic>Trauma</topic><topic>Trauma centers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Margari, Sergio</creatorcontrib><creatorcontrib>Garozzo Velloni, Fernanda</creatorcontrib><creatorcontrib>Tonolini, Massimo</creatorcontrib><creatorcontrib>Colombo, Ettore</creatorcontrib><creatorcontrib>Artioli, Diana</creatorcontrib><creatorcontrib>Allievi, Niccolò Ettore</creatorcontrib><creatorcontrib>Sammartano, Fabrizio</creatorcontrib><creatorcontrib>Chiara, Osvaldo</creatorcontrib><creatorcontrib>Vanzulli, Angelo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Emergency radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Margari, Sergio</au><au>Garozzo Velloni, Fernanda</au><au>Tonolini, Massimo</au><au>Colombo, Ettore</au><au>Artioli, Diana</au><au>Allievi, Niccolò Ettore</au><au>Sammartano, Fabrizio</au><au>Chiara, Osvaldo</au><au>Vanzulli, Angelo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study</atitle><jtitle>Emergency radiology</jtitle><stitle>Emerg Radiol</stitle><addtitle>Emerg Radiol</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>25</volume><issue>5</issue><spage>489</spage><epage>497</epage><pages>489-497</pages><issn>1070-3004</issn><eissn>1438-1435</eissn><abstract>Purpose
To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma.
Materials and methods
This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student’s
t
, chi-squared, and Cohen’s kappa tests.
Results
Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (
k
= 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (
p
< 0.05) predictors of OM. Nonoperative management (NOM) failed in 23 patients out of 191 (12.04%). In 75% of them, NOM failure occurred within 30 h from the trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (
p
< 0.05).
Conclusion
Providing detection and characterization of parenchymal and vascular traumatic lesions, MDCT plays a crucial role for safe and appropriate guidance of ED management of splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29752651</pmid><doi>10.1007/s10140-018-1607-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9900-1801</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1070-3004 |
| ispartof | Emergency radiology, 2018-10, Vol.25 (5), p.489-497 |
| issn | 1070-3004 1438-1435 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2038273951 |
| source | Springer Nature - Complete Springer Journals |
| subjects | Bleeding Computed tomography Emergency management Emergency medical services Emergency Medicine Imaging Information management Injuries Lesions Medicine Medicine & Public Health Original Article Patients Radiology Statistical analysis Statistical tests Trauma Trauma centers |
| title | Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T02%3A37%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Emergency%20CT%20for%20assessment%20and%20management%20of%20blunt%20traumatic%20splenic%20injuries%20at%20a%20Level%201%20Trauma%20Center:%2013-year%20study&rft.jtitle=Emergency%20radiology&rft.au=Margari,%20Sergio&rft.date=2018-10-01&rft.volume=25&rft.issue=5&rft.spage=489&rft.epage=497&rft.pages=489-497&rft.issn=1070-3004&rft.eissn=1438-1435&rft_id=info:doi/10.1007/s10140-018-1607-x&rft_dat=%3Cproquest_cross%3E2038273951%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2037261155&rft_id=info:pmid/29752651&rfr_iscdi=true |