Evidence map›Paper›PMID 31933042›Full record

ArticleWorld journal of surgery2020

Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa.

Matthew C Hernandez, Michael D Traynor, Ariel W Knight, Victor Y Kong, Grant L Laing, John L Bruce, Wanda Bekker, Martin D Zielinski, Damian L Clarke

Abstract read
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In one paragraph

Article in World journal of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 2 countries.

Matthew C HernandezDivision of Trauma Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA.
Michael D TraynorDivision of Trauma Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA.
Ariel W KnightDivision of Trauma Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA.
Victor Y KongDepartment of Surgery, University of Witwatersrand, Johannesburg, South Africa.
Grant L LaingDepartment of Surgery, University of KwaZulu Natal, Durban, South Africa.
John L BruceDepartment of Surgery, University of KwaZulu Natal, Durban, South Africa.
Wanda BekkerDepartment of Surgery, University of KwaZulu Natal, Durban, South Africa.
Martin D ZielinskiDivision of Trauma Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA.
Damian L ClarkeDepartment of Surgery, University of Witwatersrand, Johannesburg, South Africa. damianclar@gmail.com.
University of KwaZulu-Natal · ZAMayo Clinic in Arizona · USMayo Clinic · USMayo Clinic in Florida · USUniversity of the Witwatersrand · ZA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWe aimed to expand on the global surgical discussion around splenic trauma in order to understand locally and clinically relevant factors for operative (OP) and non-operative management (NOM) of splenic trauma in a South African setting.

methodsA retrospective cohort study was performed using 2013-2017 data from the Pietermaritzburg Metropolitan Trauma Service. All adult patients (≥15 years) were included. Those managed with OP or NOM for splenic trauma were identified and analyzed descriptively. Multiple logistic regression analysis identified patients and clinical factors associated with management type.

resultsThere were 127 patients with splenic injury. Median age was 29 [19-35] years with 42 (33%) women and 85 (67%) men. Blunt injuries occurred in the majority (81, 64%). Organ Injury Scale (OIS) grades included I (25, 20%), II (43, 34%), III (36, 28%), IV (15, 11%), and V (8, 6%). Nine patients expired. On univariate analysis, increasing OIS was associated with OP management, need for intensive care unit (ICU) admission, and hospital and ICU duration of stay, but not mortality. In patients with a delayed compared to early presentation, ICU utilization (62% vs. 36%, p = 0.008) and mortality (14% vs. 4%, p = 0.03) were increased. After adjusting for age, sex, presence of shock, and splenic OIS, penetrating trauma (adjusted odds ratio, 5.7; 95%CI, 1.7-9.8) and admission lactate concentration (adjusted odds ratio, 1.4; 95%CI 1.1-1.9) were significantly associated with OP compared to NOM (p = 0.002; area under the curve 0.81).

conclusionsWe have identified injury mechanism and admission lactate as factors predictive of OP in South African patients with splenic trauma. Timely presentation to definitive care affects both ICU duration of stay and mortality outcomes. Future global surgical efforts may focus on expanding non-operative management protocols and improving pre-hospital care in patients with splenic trauma.

Indexed as

Clinical Decision RulesConservative TreatmentAbdominal InjuriesAdolescentAdultAgedAged, 80 and overClinical Decision-MakingFemaleHumansLogistic ModelsMaleMiddle AgedRetrospective StudiesSouth AfricaSpleen

Identifiers

PMID31933042
OpenAlexW3000560710

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.