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Adult Blunt Splenic Trauma algorithm

Adult Blunt Splenic Trauma Notes:
Introduction
Historic Perspective
Table 1
Note A Table 2 Note B Note C Note D Note E Note F Table 3 Note G Note H Note I Note J Note K References

  

 
Western Trauma Association
Management of Adult Blunt Splenic Trauma

 

Annotation for Point J

 
When failure due to bleeding is dichotomized as before or after 48 hours (early vs. late), there is a low but disturbing incidence of late bleeds (2-4%) presumably due to delayed rupture of splenic artery pseudoanuerysms.26,43,44 These late bleeds tend to occur at 4 days to 8 days, but some occur weeks later. The practice of obtaining follow-up CT scans is also quite variable. The University of Tennessee Memphis group has championed the concept of obtaining CT scans before early hospital discharge of patients with high grade splenic injuries. However, their most recent series demonstrates that roughly a quarter of pseudoanuerysms occurred in grade 1 and 2 injuries and over half occurred in grade 3 injuries. This is another issue that requires prospective study before definitive recommendations can be made. In general, follow-up CT scans as out patients are not helpful but may be used selectively to confirm healing in patients who are asking to be released to pursue high risk behavior (such a bull riding or football).

 

  
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