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Splenic Injury

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21. Pediatric trauma center verification improves quality of care and reduces resource utilization in blunt splenic injury. (Abstract)

Pediatric trauma center verification improves quality of care and reduces resource utilization in blunt splenic injury.

2019 Journal of Pediatric Surgery

22. Long-term sustainability of Washington State's quality improvement initiative for the management of pediatric spleen injuries. (Abstract)

Long-term sustainability of Washington State's quality improvement initiative for the management of pediatric spleen injuries.

2018 Journal of Pediatric Surgery

23. Nonoperative Management of Blunt Splenic Trauma in Patients with Traumatic Brain Injury: Feasibility and Outcomes. (Abstract)

). We hypothesized that the presence of a TBI in patients with blunt splenic injury would lead to a higher risk of FNOM.Patients with blunt splenic injury were selected from the National Trauma Data Bank research datasets from 2007 to 2011. TBI was defined as AIS head ≥ 3 and FNOM as patients who underwent a spleen-related operation after 2 h from admission. TBI patients were compared to those without head injury. The primary outcome was FNOM.Of 47,713 patients identified, 41,436 (86.8%) underwent (...) Nonoperative Management of Blunt Splenic Trauma in Patients with Traumatic Brain Injury: Feasibility and Outcomes. Preventing secondary insult to the brain is imperative following traumatic brain injury (TBI). Although TBI does not preclude nonoperative management (NOM) of splenic injuries, development of hypotension in this setting may be detrimental and could therefore lead trauma surgeons to a lower threshold for operative intervention and a potentially higher risk of failure of NOM (FNOM

2018 World Journal of Surgery

24. Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. Full Text available with Trip Pro

Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan.We retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V) from (...) /splenorrhaphy, adjusting for known potential confounders and for within-hospital clustering using generalised estimating equation.Over time, there was a significant decrease in 30-day mortality after splenic injury (p < 0.01). Logistic regression analysis revealed that mortality significantly decreased over time (from phase I to phase II, odds ratio: 0.39, 95% confidence interval: 0.22-0.67; from phase I to phase III, odds ratio: 0.34, 95% confidence interval: 0.19-0.62) for the overall cohort. While the 30

2017 PLoS ONE

25. A cohort study to evaluate infection prevention protocol in pediatric trauma patients with blunt splenic injury in a Dutch level 1 trauma center Full Text available with Trip Pro

A cohort study to evaluate infection prevention protocol in pediatric trauma patients with blunt splenic injury in a Dutch level 1 trauma center Asplenic patients are at increased risk for the development of overwhelming postsplenectomy infection (OPSI) syndrome. It is believed that adequate immunization, antimicrobial prophylaxis, as well as appropriate education concerning risks on severe infection lead to the decreased incidence of OPSI. The aim of this study was to analyze the methods used (...) to prevent OPSI in trauma patients splenectomized before the age of 18.A retrospective, single-center study of all pediatric patients sustaining blunt splenic injury (BSI) managed at our level 1 trauma center from January 1979 to March 2012 was performed. A questionnaire was sent to all the included patients to determine the level of knowledge concerning infection risks, the use of antibiotics, and compliance to vaccination recommendations. Furthermore, we investigated whether the implementation

2018 Patient preference and adherence

26. Long-term sustainability of Washington State's quality improvement initiative for the management of pediatric spleen injuries. (Abstract)

Long-term sustainability of Washington State's quality improvement initiative for the management of pediatric spleen injuries. Initial results of Washington State's quality improvement initiative addressing the management of blunt traumatic pediatric spleen injuries were published in 2008. In this update, we evaluated whether these effects were sustained over time.Data from the Washington Trauma Registry for years 1999-2001 (pre-intervention), 2003-2005 (post-intervention), and 2012-2014 (...) (follow-up) were used in a retrospective cohort study. Children between ages 0 to 14 years who were hospitalized with a traumatic blunt spleen injury were included. Multivariable logistic regression was used to account for patient, injury, and hospital characteristics.Overall, splenectomies continued to be less common with 8.3% of pediatric patients receiving splenectomies in the follow-up period compared with 14.3% and 7.2% in the preintervention and post-intervention periods (p = 0.034). After

2018 Journal of Pediatric Surgery

27. Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies. Full Text available with Trip Pro

Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies. We investigated perforations, bleeding, and splenic injuries after screening or diagnostic colonoscopies to identify patient-, procedure-, endoscopist-, and facility-associated risk factors.We analyzed data from the SNIIRAM-PMSI national claims databases in France. A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy from 2010 (...) through 2015 were identified. Rates of severe adverse events (SAEs) were estimated using stringent and broad definitions. Risk factors associated with perforations and major bleeding were estimated using multilevel logistic regression models, adjusted for patient, colonoscopy, and endoscopist characteristics.Perforation rates ranged from 3.5 (stringent definition) to 7.3 (broad definition) per 10,000 procedures, bleeding rates ranged from 6.5 to 23.1 per 10,000 procedures, and splenic injury rates

2018 Clinical Gastroenterology and Hepatology

28. Endoscopic Retrograde Cholangiopancreatography–Induced Splenic Injury in a Patient With Sleeve Gastrectomy Full Text available with Trip Pro

Endoscopic Retrograde Cholangiopancreatography–Induced Splenic Injury in a Patient With Sleeve Gastrectomy Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure with significant complications. Splenic hematoma is an extremely rare but known complication following ERCP that has been increasingly reported in the past several years. We report the case of a 44-year-old patient with a history of sleeve gastrectomy who underwent an ERCP that was complicated by both acute (...) pancreatitis and splenic hematoma. She was managed conservatively under close monitoring in the intensive care unit. Clinicians should be aware of this potentially life-threatening complication to make a prompt diagnosis and begin early appropriate management.

2018 Journal of investigative medicine high impact case reports

29. Spleen-derived classical monocytes mediate lung ischemia-reperfusion injury through IL-1β Full Text available with Trip Pro

Spleen-derived classical monocytes mediate lung ischemia-reperfusion injury through IL-1β Ischemia-reperfusion injury, a form of sterile inflammation, is the leading risk factor for both short-term mortality following pulmonary transplantation and chronic lung allograft dysfunction. While it is well recognized that neutrophils are critical mediators of acute lung injury, processes that guide their entry into pulmonary tissue are not well understood. Here, we found that CCR2+ classical (...) monocytes are necessary and sufficient for mediating extravasation of neutrophils into pulmonary tissue during ischemia-reperfusion injury following hilar clamping or lung transplantation. The classical monocytes were mobilized from the host spleen, and splenectomy attenuated the recruitment of classical monocytes as well as the entry of neutrophils into injured lung tissue, which was associated with improved graft function. Neutrophil extravasation was mediated by MyD88-dependent IL-1β production

2018 The Journal of clinical investigation

30. Splenic involvement in umbilical cord matrix-derived mesenchymal stromal cell-mediated effects following traumatic spinal cord injury Full Text available with Trip Pro

Splenic involvement in umbilical cord matrix-derived mesenchymal stromal cell-mediated effects following traumatic spinal cord injury The spleen plays an important role in erythrocyte turnover, adaptive immunity, antibody production, and the mobilization of monocytes/macrophages (Mφ) following tissue injury. In response to trauma, the spleen initiates production of inflammatory cytokines, which in turn recruit immune cells to the inflamed tissue, exacerbating damage. Our previous work has shown (...) that intravenous mesenchymal stromal cell (MSC) infusion has potent immunomodulatory effects following spinal cord injury (SCI), associated with the transplanted cells homing to and persisting within the spleen. Therefore, this work aimed to characterize the relationship between the splenic inflammatory response and SCI pathophysiology, emphasizing splenic involvement in MSC-mediated effects.Using a rodent model of cervical clip-compression SCI, secondary tissue damage and functional recovery were compared

2018 Journal of neuroinflammation

31. Pediatric trauma center verification improves quality of care and reduces resource utilization in blunt splenic injury. Full Text available with Trip Pro

Pediatric trauma center verification improves quality of care and reduces resource utilization in blunt splenic injury. We sought to evaluate value impact of transition from an adult trauma center treating children (ATC) to a verified pediatric trauma center (PTC) in children with blunt splenic injury (BSI).Children with BSI from FY 2005 to FY 2017 were extracted from the hospital trauma registry. February 2009 distinguished "ATC" treated children from "PTC" treated children. Cohorts were (...) subcategorized into "isolated injury" and "multisystem injury". Quality and financial characteristics were statistically compared. Analysis of covariance was used to evaluate changes in quality and financial trends over the transition period. A multiple linear regression was performed to identify variables independently predictive of hospital and professional charges.126 children with BSI were identified (ATC, n = 56; PTC, n = 70). Splenic procedure rates and hospital charges decreased. Quality and cost

2018 Journal of Pediatric Surgery

32. Splenic Injury: An Unusual Complication of Colonoscopy Full Text available with Trip Pro

Splenic Injury: An Unusual Complication of Colonoscopy 29363661 2018 12 12 2018 12 12 2542-5641 131 3 2018 Feb 05 Chinese medical journal Chin. Med. J. Splenic Injury: An Unusual Complication of Colonoscopy. 372-373 10.4103/0366-6999.223864 Ungprasert Patompong P Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York 13326, USA. Jaruvongvanich Veeravich V Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii 96795, USA. eng Case Reports Letter China (...) Chin Med J (Engl) 7513795 0366-6999 IM Colonoscopy adverse effects Humans Spleen injuries 2018 1 25 6 0 2018 1 25 6 0 2018 12 13 6 0 ppublish 29363661 ChinMedJ_2018_131_3_372_223864 10.4103/0366-6999.223864 PMC5798067 Ochsner J. 2011 Fall;11(3):276-81 21960762 Dig Dis Sci. 2008 Apr;53(4):892-8 17934832 J Gastrointest Surg. 2012 Jun;16(6):1225-34 22450952 Radiology. 1987 Jan;162(1 Pt 1):69-71 3786787 South Med J. 2011 Jul;104(7):515-20 21886052

2018 Chinese medical journal

33. Delayed Splenic Rupture Resulting in Massive Intraperitoneal Hemorrhage Post Ambulatory-Related Injury Full Text available with Trip Pro

Delayed Splenic Rupture Resulting in Massive Intraperitoneal Hemorrhage Post Ambulatory-Related Injury Delayed splenic rupture, once thought to be unusual, but now growing in incidence, is an issue that could potentiate severe morbidity and mortality to patients, regardless of the severity of the trauma. This case report presents one instance of delayed splenic rupture following minor trauma and discusses the need for further investigation in the management of this condition. A middle-aged (...) after delayed splenic rupture, even with minor traumatic events. Current guidelines suggest nonoperative management of splenic injury in stable patients with low-grade splenic injuries after blunt abdominal trauma. However, with the varied presentation and difficulty in the assessment of delayed splenic rupture, patients may be exposed to undue risks with current recommendations on the management of splenic injuries. Further research is needed to find the best practice in managing, and possibly

2018 Cureus

34. Splenectomy proportions are still high in low-grade traumatic splenic injury Full Text available with Trip Pro

Splenectomy proportions are still high in low-grade traumatic splenic injury The spleen is the most vulnerable organ in blunt abdominal trauma. Spleen-preserving treatments are non-operative management with or without splenic angioembolization, partial splenectomy, and splenorrhaphy. The aim of the present study was to determine the rate of SPTs and to evaluate the usefulness of Injury Severity Score after traumatic splenic injury.We searched our institution's database between May 2012 (...) after nonoperative management. Exitus rates were 5/30 (15.1%) and 0/3 in the total splenectomy and spleen preserving treatment groups, respectively. Of the 18 hemodynamically stable patients, only 2 (11.1%) had spleen preserving treatment. Of the 19 patients with grade I-III splenic injury, only 3 (15.8%) had spleen preserving treatment. For academic and non-academic surgeons, spleen preserving treatment rates were 3/11 (27.3%) and 0/22 (0%), respectively (p<0.05). Injury severity score and mean

2018 Turkish Journal of Surgery

35. Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI). (Abstract)

Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI). After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury +2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes.Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤18 years).Of 1007 (...) children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted

2018 Journal of Pediatric Surgery

36. Disparities in the management of paediatric splenic injury. Full Text available with Trip Pro

Disparities in the management of paediatric splenic injury. The non-operative management of splenic injury in children is recommended widely, and is possible in over 95 per cent of episodes. Practice appears to vary between centres.The Trauma Audit and Research Network (TARN) database was interrogated to determine the management of isolated paediatric splenic injuries in hospitals in England and Wales. Rates of non-operative management, duration of hospital stay, readmission and mortality were (...) ). There was a significant difference in the rate of non-operative management in children of all ages. There was some improvement in non-operative management in adult hospitals in the later part of the study, but significant ongoing differences remained.The management of children with isolated splenic injury is different depending on where they are treated. The rate of non-operative management is lower in hospitals without a paediatric surgeon present.© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

2018 British Journal of Surgery

37. Reimaging in pediatric blunt spleen and liver injury. (Abstract)

Reimaging in pediatric blunt spleen and liver injury. APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients.A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without (...) pancreas or kidney injury and follow up at 14 or 60 days. Patients with re-injury after discharge were excluded.Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention.Selective abdominal

2018 Journal of Pediatric Surgery

38. Splenic Injury, Blunt, Selective Nonoperative Management of

in mortality of these injuries. [1] Pachter et al., [2] in 1998, showed that 65% of all blunt splenic injuries and could be managed nonoperatively with minimal transfusions, morbidity, or mortality, with a success rate of 98%. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. [3] Since that time, a large volume of literature (...) normal blunt abdominal trauma patient without peritonitis, an abdominal CT scan with intravenous contrast should be performed to identify and assess the severity of injury to the spleen. Angiography should be considered for patients with American Association for the Surgery of Trauma (AAST) grade of greater than III injuries, presence of a contrast blush, moderate hemoperitoneum, or evidence of ongoing splenic bleeding. Nonoperative management of splenic injuries should only be considered

2012 Eastern Association for the Surgery of Trauma

39. Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial. (Abstract)

Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial. Following blunt splenic injury, there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with pseudoaneurysm or blush.Data were collected on adult (aged ≥18 years) patients (...) with blunt splenic injury and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy.Two hundred patients with a vascular abnormality on computed tomography scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining patients, 59% underwent angiography

2017 The journal of trauma and acute care surgery Controlled trial quality: uncertain

40. Splenic Injury Embolization

objective is to compare the failure rate due to splenic bleeding between the patients undergoing pre-emptive SAE as part of NOM and the patients not undergoing SAE. The primary endpoint is the proportion of subjects failing NOM due to spleen related bleeding within 7 days of injury. All analyses will be based on an intention to treat analysis. Secondary Outcome Measures : Delayed bleeding episode [ Time Frame: 6-12 weeks ] Incidence. Delayed bleeding episode is defined as hemodynamically unstable (...) Splenic Injury Embolization Splenic Injury Embolization - the Question About NOM (SInE Qua NOM) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Splenic Injury Embolization - the Question About NOM (SInE Qua

2017 Clinical Trials

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