Traumatic brain injury with concomitant injury to the spleen: characteristics and mortality of a high-risk trauma cohort from the TraumaRegister DGU®.
Humans
Inflammation
Mortality
Splenectomy
Traumatic brain injury
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
18
08
2020
accepted:
31
10
2020
pubmed:
19
11
2020
medline:
3
12
2022
entrez:
18
11
2020
Statut:
ppublish
Résumé
Based on the hypothesis that systemic inflammation contributes to secondary injury after initial traumatic brain injury (TBI), this study aims to describe the effect of splenectomy on mortality in trauma patients with TBI and splenic injury. A retrospective cohort analysis of patients prospectively registered into the TraumaRegister DGU The cohort consisted of 1114 patients out of which 328 (29.4%) had undergone early splenectomy. Patients with splenectomy demonstrated a higher Injury Severity Score (median: 34 vs. 44, p < 0.001) and lower Glasgow Coma Scale (median: 9 vs. 7, p = 0.014) upon admission. Splenectomized patients were more frequently hypotensive upon admission (19.8% vs. 38.0%, p < 0.001) and in need for blood transfusion (30.3% vs. 61.0%, p < 0.001). The mortality was 20.7% in the splenectomy group and 10.3% in the remaining cohort. After adjustment for confounding factors, early splenectomy was not found to exert a significant effect on in-hospital mortality (OR 1.29 (0.67-2.50), p = 0.45). Trauma patients with TBI and spleen injury undergoing splenectomy demonstrate a more severe injury pattern, more compromised hemodynamic status and higher in-hospital mortality than patients without splenectomy. Adjustment for confounding factors reveals that the splenectomy procedure itself is not independently associated with survival.
Identifiants
pubmed: 33206232
doi: 10.1007/s00068-020-01544-5
pii: 10.1007/s00068-020-01544-5
pmc: PMC9712402
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4451-4459Informations de copyright
© 2020. The Author(s).
Références
J Trauma Acute Care Surg. 2015 Jan;78(1):184-91
pubmed: 25539220
Shock. 2018 Feb;49(2):154-163
pubmed: 28614141
J Neuroinflammation. 2011 Oct 31;8:148
pubmed: 22040257
Lancet. 1975 Mar 1;1(7905):480-4
pubmed: 46957
J Neurosci Res. 2008 Aug 1;86(10):2227-34
pubmed: 18381759
J Trauma Acute Care Surg. 2013 Jul;75(1):8-14; discussion 14
pubmed: 23778432
Exp Neurol. 2008 May;211(1):283-91
pubmed: 18355811
J Trauma Acute Care Surg. 2012 May;72(5):1135-9
pubmed: 22673237
Metab Brain Dis. 2012 Jun;27(2):131-41
pubmed: 22354752
Eur J Trauma Emerg Surg. 2018 Jun;44(3):335-349
pubmed: 29666944
J Neuroinflammation. 2012 Oct 12;9:236
pubmed: 23061919
J Neurotrauma. 2011 Jan;28(1):155-65
pubmed: 20954887
Transl Stroke Res. 2012 Dec;3(4):473-81
pubmed: 23956805
Surgery. 2007 Jan;141(1):32-40
pubmed: 17188165
Arch Surg. 2010 May;145(5):456-60
pubmed: 20479344
Acta Neuropathol Commun. 2014 Oct 20;2:143
pubmed: 25329434
J Trauma Acute Care Surg. 2013 Oct;75(4):596-601
pubmed: 24064871
J Cereb Blood Flow Metab. 2014 Aug;34(8):1411-9
pubmed: 24865998
J Trauma. 1974 Mar;14(3):187-96
pubmed: 4814394
Lancet Neurol. 2008 Aug;7(8):728-41
pubmed: 18635021
J Trauma. 2011 Jul;71(1):141-7
pubmed: 21248654
Crit Care. 2014 Sep 05;18(5):476
pubmed: 25394596
J Cereb Blood Flow Metab. 2006 May;26(5):654-65
pubmed: 16121126
J Immunol. 2006 Jun 1;176(11):6523-31
pubmed: 16709809
J Trauma Acute Care Surg. 2014 May;76(5):1334
pubmed: 24747473
J Surg Res. 2016 May 1;202(1):188-95
pubmed: 27083966
J Trauma Acute Care Surg. 2013 Jun;74(6):1446-53
pubmed: 23694871
J Pediatr Surg. 2003 Oct;38(10):1465-70
pubmed: 14577069
Br J Neurosurg. 2014 Apr;28(2):181-6
pubmed: 24024980
Eur J Med Res. 2009 Jul 22;14(7):284-91
pubmed: 19661010
J Neurotrauma. 2012 Apr 10;29(6):1233-42
pubmed: 22335783
Science. 2009 Jul 31;325(5940):612-6
pubmed: 19644120