Trends in hematologic markers after blunt splenic trauma: Risk factor or Epiphenomenon?

Most blunt splenic injuries (BSI) are treated with nonoperative management (NOM) or embolization (EMBO). Little is known about the hematologic changes associated with these treatments. We aim to assess the temporal changes of hematologic markers in trauma patients who undergo splenectomy (SPL), pack...

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Bibliographic Details
Published in:The American journal of surgery 2020-08, Vol.220 (2), p.489-494
Main Authors: Kovar, Alexandra, Moskowitz, Eliza, Sauaia, Angela, Moore, Ernest E., Platnick, Kenneth B., Coleman, Jamie J., Campion, Eric M., Lawless, Ryan A., Cohen, Mitchell J., Pieracci, Fredric M., Burlew, Clay Cothren
Format: Article
Language:English
Subjects:
Abscesses
Age
Blood
Blood platelets
Blunt splenic injury
Complications
Diagnostic systems
Embolization
Hematocrit
Hematologic trends
Infection
Infections
Injuries
Intervention
Leukocytes
Leukocytosis
Markers
Patients
Pneumonia
Risk analysis
Risk factors
Spleen
Splenectomy
Trauma
Trends
Urogenital system
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Summary:Most blunt splenic injuries (BSI) are treated with nonoperative management (NOM) or embolization (EMBO). Little is known about the hematologic changes associated with these treatments. We aim to assess the temporal changes of hematologic markers in trauma patients who undergo splenectomy (SPL), packing and splenorrhaphy (P/S), EMBO, or NOM. We hypothesize that differences in trends of hematologic markers exist in patients undergoing EMBO or SPL, compared to NOM. An 8-year review of adult patients with BSI and underwent SPL, EMBO, P/S, or NOM. White blood cell count (WBC), hematocrit (HCT) and platelet count (PLT) at presentation to 14 days post-admission were analyzed; post-procedural complications were reviewed. Temporal trends were compared using linear mixed-effects models. 478 patients sustained BSI, 298 (62.3%) underwent NOM, 100 (29.2%) SPL, 42 (8.8%) EMBO, and 38 (8.0%) P/S. After adjustment for age, ISS and splenic injury grade, SPL patients had a significantly higher upward trend compared to other management strategies (p 16,000 cells/ml post-SPL had a positive predictive value (PPV) of 65.2% and negative predictive value (NPV) of 76.9% for infections. Among P/S, Day 6 WBC >10,200 cells/ml had a PPV = 50% and NPV = 86.7% for infections. We observed distinct patterns of hematologic markers following BSI managed with SPL, EMBO, P/S, and NOM. Day 6 WBC increases after SPL or P/S should raise suspicion of infections and trigger a diagnostic investigation. •There are distinct temporal patterns of hematologic markers after splenectomy, embolization and nonoperative management.•Splenectomy was associated with more complications and steeper trends of WBC and PLT.•Day 6 after splenectomy, an elevated WBC is likely due to infection and should trigger diagnostic investigation.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2019.12.016