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Bloodless Laparoscopic Partial Splenectomy Assisted by Bipolar Radiofrequency Excision Hemostatic Device
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Management of High Grade Splenic Injuries in Rural America.

Michael R Burt1, Christian S Tobin1, Jenny M Guido1

  • 1Department of Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.

The American Surgeon
|July 11, 2022
PubMed
Summary
This summary is machine-generated.

Most high-grade blunt splenic injuries in rural trauma patients can be managed non-operatively without splenic artery embolization or significant blood transfusion, even with limited resources.

Keywords:
acute care surgerygeneral surgeryrural surgerytrauma

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Area of Science:

  • Trauma Surgery
  • Surgical Management
  • Emergency Medicine

Background:

  • Rural surgeons face challenges managing high-grade blunt splenic injuries (BSI) due to limited access to interventional radiology and blood products.
  • Patients may require transfer for splenic artery embolization (SAE) during ongoing resuscitation.
  • This study evaluates resource utilization in rural trauma patients with limited SAE and blood product access.

Purpose of the Study:

  • To evaluate current resource utilization in a rural trauma population with limited access to SAE and blood products.
  • To assess the feasibility of non-operative management for high-grade BSI in resource-limited settings.

Main Methods:

  • Retrospective analysis of adult patients with high-grade BSI transferred from Level 1 and Level 2 trauma centers.
  • Evaluation of resources used, including SAE, operative management (OM), and blood product utilization.
  • Primary outcomes: SAE, OM, blood product use. Secondary outcomes: Injury Severity Score (ISS), mortality.

Main Results:

  • 134 transferred patients analyzed; 16% underwent SAE, 16% OM, and 69% successful non-operative management (NOM).
  • Most patients required minimal blood products: 84% needed <3 units of packed red blood cells (PRBC), and 57% required none.
  • The majority (80%) of transferred patients required <3 total units of all combined blood products.

Conclusions:

  • The majority of transferred high-grade BSI patients were successfully managed non-operatively without SAE and with minimal transfusion.
  • Rural surgeons should consider managing high-grade splenic injuries at their home institution if no other injuries necessitate tertiary transfer.