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Journal of Trauma and Injury 2013;26(4):273-278.
CT Based Hemoperitoneum Scoring for Clinicians: Objectifying the Severity of Splenic Injury and Recovery
Hong Kyung Shin, Ra Yeong Song, Ho Seong Han, Yoo Seok Yoon, Jai Young Cho, Dae Wook Hwang, Kyuwhan Jung, Young Ki Kim, Woo Hyung Lee
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea. hanhs@snubh.org
CT를 이용한 혈복강의 등급: 비장 손상의 정도 및 회복의 객관화
신홍경1, 송라영1, 한호성, 윤유석, 조재영, 황대욱, 정규환, 김영기, 이우형
서울대학교 의과대학 분당서울대학교병원 외과
Received: 29 October 2013   • Revised: 30 October 2013   • Accepted: 30 October 2013
Abstract
PURPOSE
In patients with splenic trauma, Computed Tomography (CT) scan is helpful in selecting treatment options and evaluating resolution after NOM (Non-Operative Management). The purpose of this study was to suggest a CT based hemoperitoneum (HP) scoring system that can easily be used by clinicians to evaluate the severity of injury and recovery.
METHODS
A retrospective review of patients with splenic trauma admitted to our hospital between May 2003 and January 2013 was conducted. Patients diagnosed with isolated spleen injury who had a CT scan on admission were included. 1 or 2 points were given according to location and amount of hematoma in the CT image. Using the existing ultrasonography (US) based HP scoring system, the same method was applied to obtain our CT based HP scoring (CBHS) system, which ranges from 0 to 8 points. The CBHS system can be easily used by clinicians for a quick assessment of splenic injury.
RESULTS
Of the 39 patients meeting the inclusion criteria, 6 patients were managed operatively and 33 non-operatively. There was a significant difference in CBHS between the OM (operative management) group and the NOM group.(p=0.03) CBHS showed correlation with Hb (hemoglobin), Hct (hematocrit), spleen injury grade(AAST), and Hounsfield unit of ROI (Region of interest). (p=0.17, p=0.18, p<0.000, p=0.02, respectively) After successful NOM with stabilized Hb level, the amount of hemoperitoneum was scored in the follow-up CT. CBHS demonstrated correlation with decreased spleen injury grade, decreased Hounsfield unit of ROI (Region of interest) (p=0.039, p=0.049, respectively), and also objectively reflected patient recovery.
CONCLUSION
CBHS can be used as an objective and intuitive tool for clinicians in grading the severity of splenic injury by scoring the amount of hemoperitoneum, and in assessing recovery.
Key Words: Hemoperitoneum; Trauma; Spleen injury
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