Anesthesia Assistance in Outpatient Colonoscopy and Risk of Aspiration Pneumonia, Bowel Perforation, and Splenic Injury The increase in use of anesthesia assistance (AA) to achieve deep sedation with propofol during colonoscopy has significantly increased colonoscopy costs without evidence for increased quality and with possible harm. We investigated the effects of AA on colonoscopy complications, specifically bowel perforation, aspiration pneumonia, and splenic injury.In a population-based (...) cohort study using administrative databases, we studied adults in Ontario, Canada undergoing outpatient colonoscopy from 2005 through 2012. Patient, endoscopist, institution, and procedure factors were derived. The primary outcome was bowel perforation, defined using a validated algorithm. Secondary outcomes were splenic injury and aspiration pneumonia. Using a matched propensity score approach, we matched persons who had colonoscopy with AA (1:1) with those who did not. We used logistic regression

Conservative Management of Combined Pleural and Splenic Injury During Percutaneous Nephrostolithotomy Splenic injuries related to percutaneous nephrostolithotomy (PCNL) are infrequent. Herein, we report a combined splenic and pleural injury incurred during PCNL along with radiographic images documenting the complication. A review of management techniques for similar injuries is included.

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

Hospital characteristics associated with the management of pediatric splenic injuries. Despite evidence that more than 90% of children with traumatic injuries to the spleen can be successfully managed nonoperatively, there is significant variation in the use of splenectomy. As asplenic children are at increased risk of overwhelming postsplenectomy infection, nonoperative management may be considered a quality of care indicator.To test the hypothesis that children are more likely to undergo (...) splenectomy in general hospitals than in children's hospitals.Retrospective cohort study using data from the Kid's Inpatient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics.All children aged 0 to 16 years who were hospitalized with a traumatic (noniatrogenic) spleen injury in nonfederal short-stay hospitals in any of the 27 states participating in KID (N = 2851).Splenectomy performed within 1 day of arrival.A total of 11 children (3

of clinical study was not clearly reported. The primary health outcomes were the frequency of use of different methods of management of splenic injuries, and mortality. The nonoperative group had similar trauma scores but lower injury severity scores than the SP group. The latter group was twice as likely to be in shock on admission. The injury severity was similar between the no spleen operation (NO) and SPOR groups. The SPOR with SP group had in turn a higher rate of shock and mean injury severity score (...) at admission than the other groups. Effectiveness results Of 1255 patients who had splenic injuries, 499 had no spleen operation (NO); 596 patients had splenectomy (SP) as initial therapy; 150 underwent splenorrhaphy (SPOR), with an additional 10 patients undergoing splenorrhaphy initially and later requiring splenectomy (SPOR/SP). Overall, the percentage of patients treated with NO was 40%. The rate of mortality by group was reported as follows: NO group, 12.7%; SPOR, 5%; SP only, 14.8%; SPOR/SP 20

. Bibliographic details Keller M S, Vane D W. Management of pediatric blunt splenic injury: comparison of pediatric and adult trauma surgeons. Journal of Pediatric Surgery 1995; 30(2): 221-225 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Adolescent; Analysis of Variance; Blood Transfusion; Chi-Square Distribution; Child; Child, Preschool; Humans; Infant; Length of Stay; Outcome and Process Assessment (Health Care); Registries; Spleen /injuries /surgery; Splenectomy /adverse effects (...) Management of pediatric blunt splenic injury: comparison of pediatric and adult trauma surgeons Management of pediatric blunt splenic injury: comparison of pediatric and adult trauma surgeons Management of pediatric blunt splenic injury: comparison of pediatric and adult trauma surgeons Keller M S, Vane D W Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results