| dc.description.abstract | The spleen is one of the most commonly injured organs following blunt
abdominal trauma1. Significant evolution has occurred in the
management of splenic injuries, with a paradigm shift, from splenectomy
to non-operative management.2 In low resource centres, absent
management protocols and the lack of expertise and equipment, have
resulted in a significant number of splenic injuries being missed.3
1.2 OBJECTIVES
(i) To determine the frequency of missed splenic injuries related to
blunt abdominal trauma at the Parirenyatwa Group of Hospitals at
autopsy.
(ii) To evaluate the initial diagnostic modalities being utilised in
screening for splenic injuries.
(iii) To identify other injuries associated with missed splenic injuries at
autopsy.
1.3 STUDY DESIGN
Retrospective Descriptive autopsy study
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1.4 MATERIALS AND METHODS
Records of autopsies done over the period January 2008-December
2011were analysed in conjunction with those from casualty at the
Parirenyatwa Group of Hospitals. All autopsies performed for blunt
trauma were included in the study. Analysis was done using Stata version
10.0.
1.5 RESULTS
A total of 2171 autopsies were conducted for blunt trauma during the period
January 2008 and December 2011. Of these, 136 cases were identified as
having a missed splenic injury, giving a prevalence of 6% (p=0.001). Data
for analysis was available in 87 cases. The remaining cases (n=49) were
excluded from the study. Median age was 33 years (Q1=27, Q3=40). Male:
female ratio was 4.2:1.Road traffic accidents accounted for 86% of all
injuries. In 83% of cases, the initial attending clinician was the casualty
officer. None of the initial attending clinicians had Advanced Trauma Life
Support(ATLS® )training. Sixty per cent of cases presented with a GCS
of 3-8. Head injuries were the most common association in 46% of cases.
None of the cases had an ultrasound scan done. At autopsy, the median
volume of haemoperitoneum was 1000ml; (Q1=713 Q3=1069). The
commonest cause of death was hypovolemic shock in 60% of cases.
Combined splenic and liver injuries accounted for 40% and isolated
splenic injuries accounted for 33% of these cases.
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1.6 CONCLUSION
The study confirms that a significant number of splenic injuries were
missed by the attending clinician. A low Glasgow Coma Scale and the
presence of serious injuries were the commonest associations. The lack of
training in ATLS®, absence of protocols of managing trauma patients
and inadequate diagnostic equipment and expertise were the other
contributory factors associated with the missed splenic injuries. Early
detection and appropriate management of these cases could significantly
reduce the mortality of these polytrauma patients. | en_UZ |
