The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury
Background The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) t...
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| Veröffentlicht in: | The American surgeon 2022-04, Vol.88 (4), p.692-697 |
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| creator | Poupore, Nicolas S. Boswell, Nicole D. Baginski, Bryana Cull, John Pellizzeri, Katherine F. |
| description | Background
The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) to daily Hgb (DHgb) in this population.
Methods
We conducted a retrospective chart review of patients with BSI between 2013 and 2019. Demographics, comorbidities, lab values, clinical decisions, and outcomes were gathered through a trauma database.
Results
A total of 562 patients arrive in the trauma bay with BSI. In the NOM group, 297 were successful and 37 failed NOM. Of those that failed NOM, 8 (21.6%) changed to OM due to a drop in Hgb. 5 (62.5%) were hypotensive first, 2 (25%) were no longer receiving SHgb, and 1 (12.5%) had a repeat CT scan and was embolized. DHgb patients were not significantly different from SHgb patients in injury severity, length of stay, the largest drop in Hgb, and incidence of failing NOM. Patients taking aspirin were more likely to fall below 7 g/dl at 48 and 72 hours into admission.
Conclusions
These results suggest that that trending SHgb may not influence clinical decision-making in NOM of BSI. Besides taking aspirin, risk factors for who would benefit from SHgb were not identified. Patients who received DHgb had similar injuries and outcomes than patients who received SHgb. Prospective studies are needed to evaluate the clinical utility of SHgb compared to DHgb. |
| doi_str_mv | 10.1177/00031348211048829 |
| format | Article |
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The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) to daily Hgb (DHgb) in this population.
Methods
We conducted a retrospective chart review of patients with BSI between 2013 and 2019. Demographics, comorbidities, lab values, clinical decisions, and outcomes were gathered through a trauma database.
Results
A total of 562 patients arrive in the trauma bay with BSI. In the NOM group, 297 were successful and 37 failed NOM. Of those that failed NOM, 8 (21.6%) changed to OM due to a drop in Hgb. 5 (62.5%) were hypotensive first, 2 (25%) were no longer receiving SHgb, and 1 (12.5%) had a repeat CT scan and was embolized. DHgb patients were not significantly different from SHgb patients in injury severity, length of stay, the largest drop in Hgb, and incidence of failing NOM. Patients taking aspirin were more likely to fall below 7 g/dl at 48 and 72 hours into admission.
Conclusions
These results suggest that that trending SHgb may not influence clinical decision-making in NOM of BSI. Besides taking aspirin, risk factors for who would benefit from SHgb were not identified. Patients who received DHgb had similar injuries and outcomes than patients who received SHgb. Prospective studies are needed to evaluate the clinical utility of SHgb compared to DHgb.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348211048829</identifier><identifier>PMID: 34730033</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Abdomen ; Antihypertensives ; Aspirin ; Beta blockers ; Blood pressure ; Clinical decision making ; Coma ; Computed tomography ; Decision making ; Demographics ; Demography ; Hemoglobin ; Hemoglobins - analysis ; Hemorrhage ; Humans ; Injuries ; Injury Severity Score ; Patients ; Retrospective Studies ; Risk analysis ; Risk factors ; Spleen ; Spleen - injuries ; Splenic Diseases - diagnosis ; Splenic Diseases - therapy ; Surgery ; Trauma ; Trauma Centers ; Treatment Outcome ; Wounds, Nonpenetrating - diagnosis ; Wounds, Nonpenetrating - therapy</subject><ispartof>The American surgeon, 2022-04, Vol.88 (4), p.692-697</ispartof><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c320t-522a1c4b039a765f2480aadd7b1b23aabf3fdec01eefd5099ea4c6b5d120ae393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348211048829$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348211048829$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34730033$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poupore, Nicolas S.</creatorcontrib><creatorcontrib>Boswell, Nicole D.</creatorcontrib><creatorcontrib>Baginski, Bryana</creatorcontrib><creatorcontrib>Cull, John</creatorcontrib><creatorcontrib>Pellizzeri, Katherine F.</creatorcontrib><title>The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Background
The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) to daily Hgb (DHgb) in this population.
Methods
We conducted a retrospective chart review of patients with BSI between 2013 and 2019. Demographics, comorbidities, lab values, clinical decisions, and outcomes were gathered through a trauma database.
Results
A total of 562 patients arrive in the trauma bay with BSI. In the NOM group, 297 were successful and 37 failed NOM. Of those that failed NOM, 8 (21.6%) changed to OM due to a drop in Hgb. 5 (62.5%) were hypotensive first, 2 (25%) were no longer receiving SHgb, and 1 (12.5%) had a repeat CT scan and was embolized. DHgb patients were not significantly different from SHgb patients in injury severity, length of stay, the largest drop in Hgb, and incidence of failing NOM. Patients taking aspirin were more likely to fall below 7 g/dl at 48 and 72 hours into admission.
Conclusions
These results suggest that that trending SHgb may not influence clinical decision-making in NOM of BSI. Besides taking aspirin, risk factors for who would benefit from SHgb were not identified. Patients who received DHgb had similar injuries and outcomes than patients who received SHgb. Prospective studies are needed to evaluate the clinical utility of SHgb compared to DHgb.</description><subject>Abdomen</subject><subject>Antihypertensives</subject><subject>Aspirin</subject><subject>Beta blockers</subject><subject>Blood pressure</subject><subject>Clinical decision making</subject><subject>Coma</subject><subject>Computed tomography</subject><subject>Decision making</subject><subject>Demographics</subject><subject>Demography</subject><subject>Hemoglobin</subject><subject>Hemoglobins - analysis</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Injuries</subject><subject>Injury Severity Score</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Spleen</subject><subject>Spleen - injuries</subject><subject>Splenic Diseases - diagnosis</subject><subject>Splenic Diseases - therapy</subject><subject>Surgery</subject><subject>Trauma</subject><subject>Trauma Centers</subject><subject>Treatment Outcome</subject><subject>Wounds, Nonpenetrating - diagnosis</subject><subject>Wounds, Nonpenetrating - therapy</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE9PwkAQxTdGI4h-AC-miRcvxf3TbbtHJSokIAfg3GzbKS5pd3G3NeHbuwTURONpZjK_92byELomeEhIktxjjBlhUUoJwVGaUnGC-oRzHoqUslPU3-_DPdBDF85t_BjFnJyjHosS5nesj7LlGwSrVtWq3QWmChZglayDMTRmXZtc6WBmtGqNVXod-OnV6HC-BStb9QHBTGq5hgZ0u9c-1p1vFtsatCqCid50dneJzipZO7g61gFaPT8tR-NwOn-ZjB6mYcEobkNOqSRFlGMmZBLzikYplrIsk5zklEmZV6wqocAEoCo5FgJkVMQ5LwnFEphgA3R38N1a896Ba7NGuQLqWmowncsoFwzTJI1jj97-Qjems9p_l9GYCSJonESeIgeqsMY5C1W2taqRdpcRnO3Tz_6k7zU3R-cub6D8VnzF7YHhAXA-tp-z_zt-AmsMjBA</recordid><startdate>202204</startdate><enddate>202204</enddate><creator>Poupore, Nicolas S.</creator><creator>Boswell, Nicole D.</creator><creator>Baginski, Bryana</creator><creator>Cull, John</creator><creator>Pellizzeri, Katherine F.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>202204</creationdate><title>The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury</title><author>Poupore, Nicolas S. ; Boswell, Nicole D. ; Baginski, Bryana ; Cull, John ; Pellizzeri, Katherine F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c320t-522a1c4b039a765f2480aadd7b1b23aabf3fdec01eefd5099ea4c6b5d120ae393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdomen</topic><topic>Antihypertensives</topic><topic>Aspirin</topic><topic>Beta blockers</topic><topic>Blood pressure</topic><topic>Clinical decision making</topic><topic>Coma</topic><topic>Computed tomography</topic><topic>Decision making</topic><topic>Demographics</topic><topic>Demography</topic><topic>Hemoglobin</topic><topic>Hemoglobins - analysis</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Injuries</topic><topic>Injury Severity Score</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Spleen</topic><topic>Spleen - injuries</topic><topic>Splenic Diseases - diagnosis</topic><topic>Splenic Diseases - therapy</topic><topic>Surgery</topic><topic>Trauma</topic><topic>Trauma Centers</topic><topic>Treatment Outcome</topic><topic>Wounds, Nonpenetrating - diagnosis</topic><topic>Wounds, Nonpenetrating - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poupore, Nicolas S.</creatorcontrib><creatorcontrib>Boswell, Nicole D.</creatorcontrib><creatorcontrib>Baginski, Bryana</creatorcontrib><creatorcontrib>Cull, John</creatorcontrib><creatorcontrib>Pellizzeri, Katherine F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poupore, Nicolas S.</au><au>Boswell, Nicole D.</au><au>Baginski, Bryana</au><au>Cull, John</au><au>Pellizzeri, Katherine F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2022-04</date><risdate>2022</risdate><volume>88</volume><issue>4</issue><spage>692</spage><epage>697</epage><pages>692-697</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Background
The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) to daily Hgb (DHgb) in this population.
Methods
We conducted a retrospective chart review of patients with BSI between 2013 and 2019. Demographics, comorbidities, lab values, clinical decisions, and outcomes were gathered through a trauma database.
Results
A total of 562 patients arrive in the trauma bay with BSI. In the NOM group, 297 were successful and 37 failed NOM. Of those that failed NOM, 8 (21.6%) changed to OM due to a drop in Hgb. 5 (62.5%) were hypotensive first, 2 (25%) were no longer receiving SHgb, and 1 (12.5%) had a repeat CT scan and was embolized. DHgb patients were not significantly different from SHgb patients in injury severity, length of stay, the largest drop in Hgb, and incidence of failing NOM. Patients taking aspirin were more likely to fall below 7 g/dl at 48 and 72 hours into admission.
Conclusions
These results suggest that that trending SHgb may not influence clinical decision-making in NOM of BSI. Besides taking aspirin, risk factors for who would benefit from SHgb were not identified. Patients who received DHgb had similar injuries and outcomes than patients who received SHgb. Prospective studies are needed to evaluate the clinical utility of SHgb compared to DHgb.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>34730033</pmid><doi>10.1177/00031348211048829</doi><tpages>6</tpages></addata></record> |
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| ispartof | The American surgeon, 2022-04, Vol.88 (4), p.692-697 |
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| source | MEDLINE; SAGE Complete |
| subjects | Abdomen Antihypertensives Aspirin Beta blockers Blood pressure Clinical decision making Coma Computed tomography Decision making Demographics Demography Hemoglobin Hemoglobins - analysis Hemorrhage Humans Injuries Injury Severity Score Patients Retrospective Studies Risk analysis Risk factors Spleen Spleen - injuries Splenic Diseases - diagnosis Splenic Diseases - therapy Surgery Trauma Trauma Centers Treatment Outcome Wounds, Nonpenetrating - diagnosis Wounds, Nonpenetrating - therapy |
| title | The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury |
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