Vol.:(0123456789) 1 3 European Journal of Trauma and Emergency Surgery https://doi.org/10.1007/s00068-018-1032-6 ORIGINAL ARTICLE The need for red blood cell transfusions in the emergency department as a risk factor for failure of non-operative management of splenic trauma: a multicenter prospective study Paola Fugazzola 1  · Lucia Morganti 2  · Federico Coccolini 1  · Stefano Magnone 1  · Giulia Montori 1  · Marco Ceresoli 1  · Matteo Tomasoni 1  · Dario Piazzalunga 1  · Stefano Maccatrozzo 1  · Niccolò Allievi 1  · Savino Occhionorelli 2  · Luca Ansaloni 1 Received: 3 April 2018 / Accepted: 8 October 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Introduction The majority of patients with splenic trauma undergo non-operative management (NOM); around 15% of these cases fail NOM and require surgery. The aim of the current study is to assess whether the hemodynamic status of the patient represents a risk factor for failure of NOM (fNOM) and if this may be considered a relevant factor in the decision-making process, especially in Centers where AE (angioembolization), intensive monitoring and 24-h-operating room are not avail- able. Furthermore, the presence of additional risk factors for fNOM was investigated. Materials and methods This is a multicentre prospective observational study, including patients presenting with blunt splenic trauma older than 17 years, managed between 2014 and 2016 in two Italian trauma centres (ASST Papa Giovanni XXIII in Bergamo and Sant’Anna University Hospital in Ferrara—Italy). The risk factors for fNOM were analyzed with univariate and multivariate analyses. Results In total, 124 patients were included in the study. In univariate analysis, the risk factors for fNOM were AAST grade > 3 (fNOM 37.5% vs 9.1%, p = 0.024), and the need of red blood cell (RBC) transfusion in the emergency department (ED) (fNOM 42.9% vs 8.9%, p = 0.011). Multivariate analysis showed that the only signifcant risk factor for fNOM was the need for RBC transfusion in the ED (p = 0.049). Conclusions The current study confrms the contraindication to NOM in case of hemodynamically instability in case of splenic trauma, as indicated by the most recent guidelines; attention should be paid to patients with transient hemodynamic stability, including patients who require transfusion of RBC in the ED. These patients could beneft from AE; in centers where AE, intensive monitoring and an 24-h-operating room are not available, this particular subgroup of patients should probably be treated with operative management. Keywords Spleen trauma · Non-operative management · Trauma care · Non-operative management failure Introduction The non-operative management (NOM) is the gold-standard for the management of hemodynamically stable patients with splenic trauma without signs of peritonitis or associated injuries requiring a laparotomy [1]. NOM presents several advantages when compared to operative management (OM): a reduction in complications, mortality, costs, need of red blood cells (RBC) transfusions and, above all, the preserva- tion of the immunologic function of the spleen [2–4]. As a matter of fact, the incidence of overwhelming post-sple- nectomy infections (OPSI) is 0.5–2% and the mortality rate ranges from 30 to 70%; the majority of lethal events occur within the frst 24 h from the traumatic insult. Only prompt diagnosis and immediate treatment can reduce mortality [5, 6]. According to the current guidelines injury grade, hae- moperitoneum entity, presence of contrast blush (CB) at CT scan, Glasgow Come Scale, age, presence of associated * Paola Fugazzola paola.fugazzola@gmail.com 1 General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy 2 General Surgery Department, Sant’Anna University Hospital, Ferrara, Italy