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Patient factors associated with embolization or splenectomy within 30 days of initiating surveillance for splenic trauma

  • 期刊论文

  • 发表日期：

    2024年10月4日

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  • Fatah Tidadini,
  • Eugenie Martinet,
  • Jean-louis Quesada,
  • Alison Foote,
  • Chayma El Wafir,
  • Edouard Girard,
  • Catherine Arvieux,
  • Julio Abba,
  • Irchid Al-naasan,
  • Charles Aarteaga,
  • Sandrine Barbois,
  • Thierry Bege,
  • Jean-Paul Bergi,
  • Matthieu Biais,
  • Guillaume Bouhours,
  • Antoine Bouvier,
  • Jean-Luc Bosson,
  • Pierre Bouzat,
  • Katia Chaumoitre,
  • Jonathan Charbit,
  • Raphael Cinotti,
  • Philippe Cluzel,
  • Philippe Compagnon,
  • François Cotton,
  • Myriam Coutard,
  • Jean Louis Daban,
  • Charles Daragon,
  • Jean-Stéphane David,
  • Frederic Douane,
  • Vincent Dubuisson,
  • Anne Ego,
  • Patrice Fernandez,
  • Julien Frandon,
  • Delphine Garrigue,
  • Julien Guelfi,
  • Françoise Guillon,
  • Marc Haberlay,
  • Hassen Hentati,
  • Christophe Henry,
  • Emmanuel Hornez,
  • Hicham Kobeiter,
  • Nicolas Huet,
  • Yann Lebras,
  • Marie-Christine LEMOINE,
  • Marc Leone,
  • Emilie Lermite,
  • Nathalie Lesavre,
  • Albrice Levrat,
  • Thomas Martinilli,
  • Eric Meaudre,
  • Jean-Philippe Mestrallet,
  • Sylvie Metairie,
  • Marie Michoud,
  • Tristan Monchal,
  • Valérie Monnin-Bares,
  • Laurent Muller,
  • Jean-Robert Nzamushe,
  • Guillaume Passot,
  • Julien Picard,
  • Isabelle Plenier,
  • Bertrand Prunet,
  • Mathieu Raux,
  • Catherine Ridereau,
  • Mathieu Rodiere,
  • Christophe Teriitehau,
  • Melanie Terebus-loock,
  • Jean-Marc Thouret,
  • Frédéric Thony,
  • Christophe Tresallet,
  • Pierre-Jean Valette,
  • Antoine Vilotitch,
  • Eric Voiglio,
  • Grenoble Alpes,
  • Nîmes,
  • Bordeaux,
  • Angers,
  • Lyon Sud,
  • Montpellier,
  • Nantes,
  • Pitié-Salpêtrière,
  • Pitié-Salpêtrière Paris,
  • Henri-Mondor Créteil,
  • Annecy-Genevois,
  • Valence,
  • Chambéry,
  • Percy,
  • Sainte-Anne Toulon

摘要

Background

Non-operative management of hemodynamically stable patients with splenic trauma has been recommended for more than 25 years, but in practice embolization and/or splenectomy (intervention) is often needed within the first 30 days. Identifying the risk factors associated with the need for intervention could support more individualized decision-making.

Methods

We used data from the SPLASH randomized clinical trial, a comparison of outcomes of surveillance or embolization. 140 patients were randomized, 133 retained in the study (embolization n = 66; surveillance n = 67) and 103 screened and registered in the non-inclusion register. Multivariate Cox proportional hazards models with time-varying covariates were used to identify risk factors contributing to embolization and/or splenectomy within 30 days after initiating surveillance only for splenic trauma.

Results

123 patients (median age, 30 [23; 48] years; 91 (74%) male) initially received non-operative management. At the day-30 visit, 34 (27.6%) patients had undergone an intervention (31 (25.2%) delayed embolization and 4 (3.3%) splenectomy). Multivariate analysis identified patients with OIS grade 4 or 5 splenic trauma (HR = 4.51 [2.06–9.88]) and (HR = 34.5 [6.84–174]); respectively) and splenic complications: arterial leak (HR = 1.80 [1.45–2.24]), pseudoaneurysm (HR = 1.22 [1.06–1.40]) and pseudocyst (HR = 1.41 [1.21–1.64]) to be independently associated with increased risk of need for an intervention within 30 days of initiating surveillance.

Conclusions

Our study shows that more than 1 in 4 patients who received non-operative management needed embolization or splenectomy by day 30. Arterial leak, pseudoaneurysm, pseudocyst, and OIS grade 4 or 5 were independent risk factors linked to the need for an intervention.

TRIAL REGISTRATION

clinicaltrials.gov Identifier NCT 02021396.

Graphical abstract