Nonoperative Management in Blunt Splenic Trauma: Can Shock Index Predict Failure?

• DOI: 10.1016/j.jss.2022.02.035
• Publication Date: 2022-04-12T19:09:24Z
• Authors: Lara Senekjian; Bryce R.H. Robinson; Ashley D. Meagher; Joel A. Gross; Ronald V. Maier; Eileen M. Bulger; Saman Arbabi; Joseph Cuschieri
• Keywords: Trauma Center; Blunt trauma; Univariate analysis

IntroductionPredicting failure of nonoperative management (NOM) in splenic trauma remains elusive. Shock index (SI) is an indicator physiologic burden injury but not used as a prediction tool. The purpose this study was to determine if elevated SI would be predictive NOM patients with blunt injury.MethodsAdult admitted level-1 center from January 2011 April 2017 for were reviewed. Patients excluded they underwent procedure (angiography or surgery) prior admission. primary outcome requiring intervention after initial trial noninterventional (NIM). An > 0.9 at admission considered high risk. Univariate and multivariate analyses identify predicators the NOM. Findings subsequently verified on validation cohort patients.ResultsFive hundred eighty-five met inclusion criteria; 7.4% failed NIM. On univariate analysis, findings pseudoaneurysm extra-arterial contrast computed tomography did differentiate successful NIM versus (8.1% 14.0%, P = 0.18). Age, American Association Surgery Trauma grade, included modeling. Grade (OR 3.49, 0.001), age 1.02, 0.009), 0.001) each independently significant failure. risk-adjusted odds significantly higher risk 2.35, < 0.001). Validation these confirmed subsequent 406 c-statistic 0.71 (95% CI 0.62-0.80).ConclusionsElevated independent factor those injury. along may aid predicting providers should incorporate into decision-making tools management.