Impact of the establishment of a trauma center on blunt traumatic spleen injury treatment: Comparison between pre-traumatic center and trauma center periods

BACKGROUND: The spleen is a commonly injured intra-abdominal organ from blunt trauma. In cases of traumatic blunt spleen injury, immediate treatment is often required. This study aimed to investigate the prognostic impact of the establishment of a trauma center on the treatment of patients with blunt trauma injury to the spleen.
METHODS: We retrospectively reviewed 235 patients who visited our center from 2012 to 2019 for blunt trauma injury to the spleen. The study period was divided into two groups: January 2012 to September 2015 was the pre-center period (PCP), and September 2015 to December 2019 was the trauma center period (TCP). In each period, there were three treatment groups: Surgical group, embolization group, and conservative treatment group. The primary outcome was mortality, and the secondary outcomes were patient characteristics, such as injury severity score and abbreviated injury scale score, time from admission to intervention (both surgery and angiography embolization), and rate of spleen-preserving surgery.
RESULTS: In the conservative treatment group, the Hb and hct values were relatively low in the TCP than in the PCP (p=0.007, p=0.008, respectively). The intensive care unit admission rate was relatively high in the TCP (72.9% vs. 90.6%, p=0.031). The ISS was relatively low in the TCP (18 vs. 17, p=0.001). In the surgical group, the time taken to transfer patients to the operating room after admission was greatly reduced in the TCP (151 min vs. 107 min, p=0.028). In the embolization group, the patient’s age and SBP were lower in the PCP than in the TCP (p=0.003, p=0.049, respectively); three patients had undergone embolization with CPR in the PCP, and no patient underwent CPR in the TCP. There were three deaths in PCP and none in the TCP (p=0.05).
CONCLUSION: The establishment of a trauma center has led to improvements in the treatment quality and prognosis of patients with blunt trauma injury to the spleen receiving either of the three treatments.

Travma merkezleri kurulmasýnýn künt travmatik dalak yaralanmasý tedavisi üzerine etkisi: Travma merkezleri öncesi ve sonrasý dönemlerin karþýlaþtýrýlmasý

AMAÇ: Dalak, künt travma nedeniyle yaygýn olarak yaralanan bir batýn içi organdýr. Künt dalak yaralanmasý vakalarýnda sýklýkla acil tedavi gerekir. Bu çalýþma, künt dalak yaralanmasý olan hastalarýn tedavisinde travma merkezleri kurulmasýnýn prognostik etkisini araþtýrmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: 2012–2019 yýllarý arasýnda dalakta künt yaralanma nedeniyle merkezimizi ziyaret eden 235 hastayý geriye dönük olarak inceledik. Çalýþma süresi iki gruba ayrýldý: Ocak 2012–Eylül 2015 arasý travma merkezi öncesi dönem (TÖD) ve Eylül 2015–Aralýk 2019 arasý travma merkezi dönemi (TMD). Her bir dönemde, üç tedavi grubu mevcuttu: Cerrahi grup, embolizasyon grubu ve konservatif tedavi grubu. Birincil sonuç mortalite idi; ikincil sonuçlar ise, yaralanma þiddeti skoru (ISS) ve kýsaltýlmýþ yaralanma ölçeði puaný gibi hasta özellikleri, baþvurudan müdahaleye kadar geçen süre (hem cerrahi hem de anjiyografi embolizasyonu) ve dalak koruyucu cerrahi oraný idi.
BULGULAR: Konservatif tedavi grubunda TMD’de Hb ve Hct deðerleri, TÖD’ye göre nispeten düþüktü (sýrasýyla, p=0.007, p=0.008). TMD’de yoðun bakýma yatýþ oraný nispeten yüksekti (%72.9’a karþý %90.6, p=0.031). TMD’de yaralanma þiddeti skoru (ISS) nispeten düþüktü (18’e karþý 17, p=0.001). Cerrahi grubunda, hasta kabulünden sonra ameliyathaneye transfer için geçen süre TMP’de büyük ölçüde azalmýþtýr (151 dakikaya karþý 107 dakika, p=0.028). Embolizasyon grubunda hastanýn yaþý ve SBP, TÖD’de TMD’ye göre daha düþüktü (sýrasýyla p=0.003, p=0.049); TÖD’de üç hastaya CPR ile embolizasyon uygulanmýþ, TMD’de ise hiçbir hastaya CPR uygulanmamýþtý. TÖD’de üç ölüm mevcuttu; TMD’de hiç ölüm gerçekleþmemiþti (p=0.05).
TARTIÞMA: Bir travma merkezinin kurulmasý, künt dalak yaralanmasý olan ve üç tedaviden birini alan hastalarýn tedavi kalitesinde ve prognozunda iyileþmelere yol açmýþtýr.