Epidemiology and management of splenic injury: An analysis of a Chinese military registry

Chen,Yong; Qiu,Jun; Yang,Ao; Yuan,Danfeng; Zhou,Jihong

doi:10.3892/etm.2017.4208

Epidemiology and management of splenic injury: An analysis of a Chinese military registry

Authors:
- Yong Chen
- Jun Qiu
- Ao Yang
- Danfeng Yuan
- Jihong Zhou
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Affiliations: State Key Laboratory of Trauma, Burns and Combined Injury, Department 4, Research Institute of Surgery, Daping Hospital, The Third Military Medical University, Chongqing 400042, P.R. China
Published online on: March 9, 2017 https://doi.org/10.3892/etm.2017.4208
Pages: 2102-2108

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Abstract

In China, there have been few meta-analyses of the epidemiology and management of splenic injury. Due to the success of Chinese military hospitals in the domestic treatment of splenic injury, the present study conducted a systematic review of such cases, identifying a high occurrence rate of splenic trauma, as well as a number of strategies of managing splenic injury in China. Data were collected from sixteen Chinese military hospitals between July 2000 and March 2009, and retrospectively reviewed. It was observed that between July 2000 and March 2009 a total of 7,807 patients (84.32% male and 15.68% female) with splenic injury were admitted to hospital. The mean duration of hospital stay was 17.9±18.6 days and the gender distribution of splenic injury over the successive years did not differ significantly (P>0.05, c=0.034). However, there was a significant difference in the gender distribution of splenic injury patients in different months (P<0.05, c=0.063). In addition, admission numbers for splenic injury were highest in September, October and November. It was also found that splenic injury may occur at all ages, though patients of working age (20-50 years), which comprises 85.59% of patients, the highest proportion of all recorded cases. Associations between mortality rate and each management strategy were as follows: Operative management, 0.11% and non‑operative management, 0.15%. Furthermore, multivariate analysis demonstrated that transfusion, New Injury Severity Score and management strategies were all correlated with mortality rate. Thus, despite a lack of data for inpatients from civilian hospitals, the present study has, in part, identified the epidemiology and management strategies of splenic injury in China. These findings may supplement those from previous analyses of splenic injury in other countries and regions.

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1	World Health Organization: World Health Statistical. 2011 http://www.who.int/gho/publications/world_health_statistics/EN_WHS2011_Full.pdfAccessed. November 28–2011.
2	Chiotoroiu AL, Venter DM, Negoi I, Vartosu C, Plotogea O, Paun S, Vartic M and Beuran M: Splenic implant assessment in trauma. Chirurgia (Bucur). 109:731–740. 2014.PubMed/NCBI
3	Cirocchi R, Corsi A, Castellani E, Chiotoroiu AL, Venter DM, Negoi I, Vartosu C, Plotogea O, Paun S, Vartic M and Beuran M: Case series of non-operative management vs. operative management of splenic injury after blunt trauma. Ulus Travma Acil Cerrahi Derg. 20:91–96. 2014. View Article : Google Scholar : PubMed/NCBI
4	Sakran JV, Greer SE, Werlin E and McCunn M: Care of the injured worldwide: Trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med. 20:642012. View Article : Google Scholar : PubMed/NCBI
5	Wang SY, Li YH, Chi GB, Xiao SY, Ozanne-Smith J, Stevenson M and Phillips MR: Injury-related fatalities in China: An under-recognised public-health problem. Lancet. 372:1765–1773. 2008. View Article : Google Scholar : PubMed/NCBI
6	Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G and Stella F: The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir. 81:95–102. 2010.PubMed/NCBI
7	Zhang L, Liu X, Li Y, Liu Y, Liu Z, Lin J, Shen J, Tang X, Zhang Y and Liang W: Emergency medical rescue efforts after a major earthquake: Lessons from the 2008 Wenchuan earthquake. Lancet. 379:853–861. 2012. View Article : Google Scholar : PubMed/NCBI
8	Xu JH, Qiu J, Zhou JH, Zhang L, Yuan DF, Dai W and Gao ZM: Pediatric burns in military hospitals of China from 2001 to 2007: A retrospective study. Burns. 40:1780–1788. 2014. View Article : Google Scholar : PubMed/NCBI
9	Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA and Champion HR: Organ injury scaling: Spleen and liver (1994 revision). J Trauma. 38:323–324. 1995. View Article : Google Scholar : PubMed/NCBI
10	Hildebrand DR, Ben-Sassi A, Ross NP, Macvicar R, Frizelle FA and Watson AJ: Modern management of splenic trauma. BMJ. 348:g18642014. View Article : Google Scholar : PubMed/NCBI
11	Soo KM, Lin TY, Chen CW, Lin YK, Kuo LC, Wang JY, Lee WC and Lin HL: More becomes less: Management strategy has definitely changed over the past decade of splenic injury-a nationwide population-based study. Biomed Res Int. 2015:1249692015. View Article : Google Scholar : PubMed/NCBI
12	Hazlitt M, Hill JB, Gunter OL and Guillamondegui OD: Disparities in trauma: The impact of socioeconomic factors on outcomes following traumatic hollow viscus injury. J Surg Res. 191:6–11. 2014. View Article : Google Scholar : PubMed/NCBI
13	Greene WR, Oyetunji TA, Bowers U, Haider AH, Mellman TA, Cornwell EE, Siram SM and Chang DC: Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma. Am J Surg. 199:554–557. 2010. View Article : Google Scholar : PubMed/NCBI
14	Singer DB: Postsplenectomy sepsis. Perspect Pediatr Pathol. 1:285–311. 1973.PubMed/NCBI
15	Davies DA, Pearl RH, Ein SH, Langer JC and Wales PW: Management of blunt splenic injury in children: Evolution of the non-operative approach. J Pediatr Surg. 44:1005–1008. 2009. View Article : Google Scholar : PubMed/NCBI
16	Hoskins W, Jacob A, Wijeratne S, Campbell I and Taylor P: Splenic injury admitted to a rural Level 3 trauma centre: A 10-year audit. Aust J Rural Health. 21:163–169. 2013. View Article : Google Scholar : PubMed/NCBI
17	Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, et al: Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 73:S294–S300. 2012. View Article : Google Scholar : PubMed/NCBI
18	Frandon J, Rodiere M, Arvieux C, Vendrell A, Boussat B, Sengel C, Broux C, Bricault I, Ferretti G and Thony F: Blunt splenic injury: Are early adverse events related to trauma, nonoperative management, or surgery? Diagn Interv Radiol. 21:327–333. 2015. View Article : Google Scholar : PubMed/NCBI
19	Cirocchi R, Boselli C, Corsi A, Farinella E, Listorti C, Trastulli S, Renzi C, Desiderio J, Santoro A, Cagini L, et al: Is non-operative management safe and effective for all splenic blunt trauma? A systematic review. Crit Care. 17:R1852013. View Article : Google Scholar : PubMed/NCBI
20	Cocanour CS: Blunt splenic injury. Curr Opin Crit Care. 16:575–581. 2010. View Article : Google Scholar : PubMed/NCBI
21	Watson GA, Hoffman MK and Peitzman AB: Nonoperative management of blunt splenic injury: What is new? Eur J Trauma Emerg Surg. 41:219–228. 2015. View Article : Google Scholar : PubMed/NCBI
22	Olthof DC, Joosse P, van der Vlies CH, de Haan RJ and Goslings JC: Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: A systematic review. J Trauma Acute Care Surg. 74:546–557. 2013. View Article : Google Scholar : PubMed/NCBI
23	Rostas J, Cason B, Simmons J, Frotan MA, Brevard SB and Gonzalez RP: The validity of abdominal examination in blunt trauma patients with distracting injuries. J Trauma Acute Care Surg. 78:1095–1101. 2015. View Article : Google Scholar : PubMed/NCBI
24	Peitzman AB: Focus on blunt abdominal trauma. Eur J Trauma Emerg Surg. 41:2172015. View Article : Google Scholar : PubMed/NCBI
25	Robinson WP III, Ahn J, Stiffler A, Rutherford EJ, Hurd H, Zarzaur BL, Baker CC, Meyer AA and Rich PB: Blood transfusion is an independent predictor of increased mortality in nonoperatively managed blunt hepatic and splenic injuries. J Trauma. 58:437–445. 2005. View Article : Google Scholar : PubMed/NCBI
26	Aubrey-Bassler FK and Sowers N: 613 cases of splenic rupture without risk factors or previously diagnosed disease: A systematic review. BMC Emerg Med. 12:112012. View Article : Google Scholar : PubMed/NCBI
27	Duron VP, Day KM, Steigman SA, Aidlen JT and Luks FI: Maintaining low transfusion and angioembolization rates in the age of nonoperative management of pediatric blunt splenic injury. Am Surg. 80:1159–1163. 2014.PubMed/NCBI