New insight for management of blunt splenic trauma: Significant differences between young and elderly

Kouji Tsugawa, Nobuhiro Koyanagi, Makoto Hashizume, Katsuhiko Ayukawa, Hiroya Wada, Morimasa Tomikawai, Keizo Sugimachi

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background/Aims: Although highly successful in children and young patients, the non-operative management of blunt splenic injury in the elderly has yet to be clearly studied. The purpose of this study was to determine whether or not a relationship exists among the mechanism of injury, the grade of splenic injury, the associated injuries, and whether patterns of injury differ between the young group (younger than 60 years old) and the elderly group (60 years and older than 60 years). Methodology: One hundred and sixty-seven patients (116 young patients including 30 early deaths and 51 elderly patients including 20 early deaths) with blunt splenic injury were admitted to our clinic from 1983 to 1997. Computed tomography scans were interpreted in a blind fashion. In addition, the Injury Severity Score, Glasgow Coma Scale, blunt splenic injury grade, length of hospital stay, length of intensive care unit stay, survival, number of abdominal injuries and number of total diagnoses were investigated in both the young and elderly groups. The different types of management for blunt splenic injury were also studied. Results: Higher injury severity scores, lower Glasgow Coma Scales, and higher mortality all indicated that the elderly were more severely injured than the young patients. The rate of non-operative treatment was also significantly greater for young patients than for elderly patients (62.8 vs. 32.3%, P<0.05) and the rate of a splenectomy was significantly less for the young patients than for the elderly patients (29.1 vs. 51.6%, P<0.05). Regarding infectious complications, the rates of pneumonia (14.0 vs. 23.1%, P<0.05), subphrenic abscess (9.3 vs. 23. 1%, P<0.05), and urosepsis (7.0 vs. 23. 1%, P<0.05) was significantly greater for the elderly patients than for the young patients. The overall failure of non-operative management was 5.2% in the young patients and 9.8% in the elderly patients. Conclusions: The final selection of splenic management decision was individualized for each patient and based on multiple variables. For persistent hemodynamic instability or unresolved concerns for other individual pathologic conditions, aggressive management is recommended. In the absence of these two important conditions, the variables that predicted a need for operative intervention include an Injury Severity Score above 20 in younger and elderly patients; an American Association for the Surgery of Trauma splenic grade above III in elderly; a large hemoperitoneum on an initial computed tomography scan; the presence of active extravasation on an initial computed tomography scan; and high-energy mechanisms. In conclusion, selecting the optimal non-operative management of blunt splenic injury in elderly patients remains difficult. An aggressive initial operation is thus recommended because the specific fragility of the spleen and the decreased physiologic reserve in elderly patients is difficult to estimate, especially at small hospitals where performing emergency splenic angiography and treating embolisms is difficult.

Original languageEnglish
Pages (from-to)1144-1149
Number of pages6
JournalHepato-Gastroenterology
Volume49
Issue number46
Publication statusPublished - Jan 1 2002

Fingerprint

Wounds and Injuries
Nonpenetrating Wounds
Injury Severity Score
Glasgow Coma Scale
Tomography
Length of Stay
Subphrenic Abscess
Hemoperitoneum
Abdominal Injuries
Splenectomy
Embolism
Intensive Care Units
Pneumonia
Angiography
Emergencies
Spleen
Hemodynamics
Survival
Mortality

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Tsugawa, K., Koyanagi, N., Hashizume, M., Ayukawa, K., Wada, H., Tomikawai, M., & Sugimachi, K. (2002). New insight for management of blunt splenic trauma: Significant differences between young and elderly. Hepato-Gastroenterology, 49(46), 1144-1149.

New insight for management of blunt splenic trauma : Significant differences between young and elderly. / Tsugawa, Kouji; Koyanagi, Nobuhiro; Hashizume, Makoto; Ayukawa, Katsuhiko; Wada, Hiroya; Tomikawai, Morimasa; Sugimachi, Keizo.

In: Hepato-Gastroenterology, Vol. 49, No. 46, 01.01.2002, p. 1144-1149.

Research output: Contribution to journalArticle

Tsugawa, K, Koyanagi, N, Hashizume, M, Ayukawa, K, Wada, H, Tomikawai, M & Sugimachi, K 2002, 'New insight for management of blunt splenic trauma: Significant differences between young and elderly', Hepato-Gastroenterology, vol. 49, no. 46, pp. 1144-1149.
Tsugawa K, Koyanagi N, Hashizume M, Ayukawa K, Wada H, Tomikawai M et al. New insight for management of blunt splenic trauma: Significant differences between young and elderly. Hepato-Gastroenterology. 2002 Jan 1;49(46):1144-1149.
Tsugawa, Kouji ; Koyanagi, Nobuhiro ; Hashizume, Makoto ; Ayukawa, Katsuhiko ; Wada, Hiroya ; Tomikawai, Morimasa ; Sugimachi, Keizo. / New insight for management of blunt splenic trauma : Significant differences between young and elderly. In: Hepato-Gastroenterology. 2002 ; Vol. 49, No. 46. pp. 1144-1149.
@article{fab5223dde094c57a4e676dc6a92f7d7,
title = "New insight for management of blunt splenic trauma: Significant differences between young and elderly",
abstract = "Background/Aims: Although highly successful in children and young patients, the non-operative management of blunt splenic injury in the elderly has yet to be clearly studied. The purpose of this study was to determine whether or not a relationship exists among the mechanism of injury, the grade of splenic injury, the associated injuries, and whether patterns of injury differ between the young group (younger than 60 years old) and the elderly group (60 years and older than 60 years). Methodology: One hundred and sixty-seven patients (116 young patients including 30 early deaths and 51 elderly patients including 20 early deaths) with blunt splenic injury were admitted to our clinic from 1983 to 1997. Computed tomography scans were interpreted in a blind fashion. In addition, the Injury Severity Score, Glasgow Coma Scale, blunt splenic injury grade, length of hospital stay, length of intensive care unit stay, survival, number of abdominal injuries and number of total diagnoses were investigated in both the young and elderly groups. The different types of management for blunt splenic injury were also studied. Results: Higher injury severity scores, lower Glasgow Coma Scales, and higher mortality all indicated that the elderly were more severely injured than the young patients. The rate of non-operative treatment was also significantly greater for young patients than for elderly patients (62.8 vs. 32.3{\%}, P<0.05) and the rate of a splenectomy was significantly less for the young patients than for the elderly patients (29.1 vs. 51.6{\%}, P<0.05). Regarding infectious complications, the rates of pneumonia (14.0 vs. 23.1{\%}, P<0.05), subphrenic abscess (9.3 vs. 23. 1{\%}, P<0.05), and urosepsis (7.0 vs. 23. 1{\%}, P<0.05) was significantly greater for the elderly patients than for the young patients. The overall failure of non-operative management was 5.2{\%} in the young patients and 9.8{\%} in the elderly patients. Conclusions: The final selection of splenic management decision was individualized for each patient and based on multiple variables. For persistent hemodynamic instability or unresolved concerns for other individual pathologic conditions, aggressive management is recommended. In the absence of these two important conditions, the variables that predicted a need for operative intervention include an Injury Severity Score above 20 in younger and elderly patients; an American Association for the Surgery of Trauma splenic grade above III in elderly; a large hemoperitoneum on an initial computed tomography scan; the presence of active extravasation on an initial computed tomography scan; and high-energy mechanisms. In conclusion, selecting the optimal non-operative management of blunt splenic injury in elderly patients remains difficult. An aggressive initial operation is thus recommended because the specific fragility of the spleen and the decreased physiologic reserve in elderly patients is difficult to estimate, especially at small hospitals where performing emergency splenic angiography and treating embolisms is difficult.",
author = "Kouji Tsugawa and Nobuhiro Koyanagi and Makoto Hashizume and Katsuhiko Ayukawa and Hiroya Wada and Morimasa Tomikawai and Keizo Sugimachi",
year = "2002",
month = "1",
day = "1",
language = "English",
volume = "49",
pages = "1144--1149",
journal = "Acta hepato-splenologica",
issn = "0172-6390",
publisher = "H.G.E. Update Medical Publishing Ltd.",
number = "46",

}

TY - JOUR

T1 - New insight for management of blunt splenic trauma

T2 - Significant differences between young and elderly

AU - Tsugawa, Kouji

AU - Koyanagi, Nobuhiro

AU - Hashizume, Makoto

AU - Ayukawa, Katsuhiko

AU - Wada, Hiroya

AU - Tomikawai, Morimasa

AU - Sugimachi, Keizo

PY - 2002/1/1

Y1 - 2002/1/1

N2 - Background/Aims: Although highly successful in children and young patients, the non-operative management of blunt splenic injury in the elderly has yet to be clearly studied. The purpose of this study was to determine whether or not a relationship exists among the mechanism of injury, the grade of splenic injury, the associated injuries, and whether patterns of injury differ between the young group (younger than 60 years old) and the elderly group (60 years and older than 60 years). Methodology: One hundred and sixty-seven patients (116 young patients including 30 early deaths and 51 elderly patients including 20 early deaths) with blunt splenic injury were admitted to our clinic from 1983 to 1997. Computed tomography scans were interpreted in a blind fashion. In addition, the Injury Severity Score, Glasgow Coma Scale, blunt splenic injury grade, length of hospital stay, length of intensive care unit stay, survival, number of abdominal injuries and number of total diagnoses were investigated in both the young and elderly groups. The different types of management for blunt splenic injury were also studied. Results: Higher injury severity scores, lower Glasgow Coma Scales, and higher mortality all indicated that the elderly were more severely injured than the young patients. The rate of non-operative treatment was also significantly greater for young patients than for elderly patients (62.8 vs. 32.3%, P<0.05) and the rate of a splenectomy was significantly less for the young patients than for the elderly patients (29.1 vs. 51.6%, P<0.05). Regarding infectious complications, the rates of pneumonia (14.0 vs. 23.1%, P<0.05), subphrenic abscess (9.3 vs. 23. 1%, P<0.05), and urosepsis (7.0 vs. 23. 1%, P<0.05) was significantly greater for the elderly patients than for the young patients. The overall failure of non-operative management was 5.2% in the young patients and 9.8% in the elderly patients. Conclusions: The final selection of splenic management decision was individualized for each patient and based on multiple variables. For persistent hemodynamic instability or unresolved concerns for other individual pathologic conditions, aggressive management is recommended. In the absence of these two important conditions, the variables that predicted a need for operative intervention include an Injury Severity Score above 20 in younger and elderly patients; an American Association for the Surgery of Trauma splenic grade above III in elderly; a large hemoperitoneum on an initial computed tomography scan; the presence of active extravasation on an initial computed tomography scan; and high-energy mechanisms. In conclusion, selecting the optimal non-operative management of blunt splenic injury in elderly patients remains difficult. An aggressive initial operation is thus recommended because the specific fragility of the spleen and the decreased physiologic reserve in elderly patients is difficult to estimate, especially at small hospitals where performing emergency splenic angiography and treating embolisms is difficult.

AB - Background/Aims: Although highly successful in children and young patients, the non-operative management of blunt splenic injury in the elderly has yet to be clearly studied. The purpose of this study was to determine whether or not a relationship exists among the mechanism of injury, the grade of splenic injury, the associated injuries, and whether patterns of injury differ between the young group (younger than 60 years old) and the elderly group (60 years and older than 60 years). Methodology: One hundred and sixty-seven patients (116 young patients including 30 early deaths and 51 elderly patients including 20 early deaths) with blunt splenic injury were admitted to our clinic from 1983 to 1997. Computed tomography scans were interpreted in a blind fashion. In addition, the Injury Severity Score, Glasgow Coma Scale, blunt splenic injury grade, length of hospital stay, length of intensive care unit stay, survival, number of abdominal injuries and number of total diagnoses were investigated in both the young and elderly groups. The different types of management for blunt splenic injury were also studied. Results: Higher injury severity scores, lower Glasgow Coma Scales, and higher mortality all indicated that the elderly were more severely injured than the young patients. The rate of non-operative treatment was also significantly greater for young patients than for elderly patients (62.8 vs. 32.3%, P<0.05) and the rate of a splenectomy was significantly less for the young patients than for the elderly patients (29.1 vs. 51.6%, P<0.05). Regarding infectious complications, the rates of pneumonia (14.0 vs. 23.1%, P<0.05), subphrenic abscess (9.3 vs. 23. 1%, P<0.05), and urosepsis (7.0 vs. 23. 1%, P<0.05) was significantly greater for the elderly patients than for the young patients. The overall failure of non-operative management was 5.2% in the young patients and 9.8% in the elderly patients. Conclusions: The final selection of splenic management decision was individualized for each patient and based on multiple variables. For persistent hemodynamic instability or unresolved concerns for other individual pathologic conditions, aggressive management is recommended. In the absence of these two important conditions, the variables that predicted a need for operative intervention include an Injury Severity Score above 20 in younger and elderly patients; an American Association for the Surgery of Trauma splenic grade above III in elderly; a large hemoperitoneum on an initial computed tomography scan; the presence of active extravasation on an initial computed tomography scan; and high-energy mechanisms. In conclusion, selecting the optimal non-operative management of blunt splenic injury in elderly patients remains difficult. An aggressive initial operation is thus recommended because the specific fragility of the spleen and the decreased physiologic reserve in elderly patients is difficult to estimate, especially at small hospitals where performing emergency splenic angiography and treating embolisms is difficult.

UR - http://www.scopus.com/inward/record.url?scp=0036021379&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036021379&partnerID=8YFLogxK

M3 - Article

C2 - 12143223

AN - SCOPUS:0036021379

VL - 49

SP - 1144

EP - 1149

JO - Acta hepato-splenologica

JF - Acta hepato-splenologica

SN - 0172-6390

IS - 46

ER -