Observation of Splenic Injuries - Forum

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Surgeon

Observation of Splenic Injuries - Ärzteforum

Post#1 »

Two questions:

1. How long are people observing isolated splenic injuries for in the hospital, assuming their hemoglobin/hematocrit are stable?

2. How long do you tell these patients to restrict vigorous activity? How long till they can resume sports?


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Billroth

Re: Observation of Splenic Injuries - Ärzteforum

Post#2 »

>1.

Here at UK, if Ht is stable we usually keep them in the ICU vs. monitored
bed for 2-3 days, and then gradually advance their physical activities and
diet as tolerated. D/c home on day 5-6 if stable. They usually feel better
every day and this is the best indicator of recovery.

>2.

Usually 6 weeks. There are recommendations for f/u US and/or abd CT to
evaluate healing of the injury before gradual resuming vigorous physical
activities, but I'm nor aware of any supporting prospective data.

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A Doctor

Re: Observation of Splenic Injuries - Ärzteforum

Post#3 »

You may as well flip a coin as no one knows the answer--as many opinions will
come up as the number of surgeons who answer, for whatever worth it is to you
IWe generally discharge the patient whenever they are ready to go, over their
associated injuries and eating without problem. Contact sports is a matter we
err on the side of caution, not knowing--3 months is a good time, since wound
healing to normal tensile strength is complete by that time. You will no
doubt get a bunch of answers saying they, or you should, get a followup CT
scan to document "healing", tho I continue to be mystified how a shadow on a
strip of celluloid in any way documents this--and there is not a shred of
evidence to justify this wasting of money--challenge any who say this to cite
for us the evidence to justify,, and challenge any who even start to talk
about medical liability to go back to medical school to re-learn what the
practice of medicine is and should be, and how it is different from law
school.

Noro

Re: Observation of Splenic Injuries - Ärzteforum

Post#4 »

Way too long if no other problems are going on--a huge waste of resources for
such a completely unfounded regimen, which is obviously treating you more than
the patient--why then don't YOU pay for the hospitalization?

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Lady Surgeon

Re: Observation of Splenic Injuries - Ärzteforum

Post#5 »

Do you have any data to support the fact that sending a patient with a
Grade II splenic injury home on the 2nd hospital day is NOT malpractice? Do
you give them Pneumovax before they go home, so that when they return 2 days
later and undergo delayed splenectomy..they will already be vaccinated?
Unfortunately lot of what we do nowadays has no discrete data to define what
is "optimal." Unfortunately, in many areas of the country there are more
lawyers than doctors. As far as my patients are concerned...I usually keep
them in ICU for 1-2 days...until I am reasonably sure that they are
hemodynamically stable and are not still bleeding. I get them out of bed at
that point, ambulate them, feed them as tolerated, and discharge them when
their pain is well controlled, and when I am sure that atelectasis is not
going to be a problem. They usually go home about 4-5 days after their
injury. I recommend no "excessive" activity (e.g. contact sports or
activities at high risk for trauma such as Bungie jumping for 12 weeks) A lot
of what we do is truly dogmatic..but seems to be safe and that's why I do it.

Surrgeon

Re: Observation of Splenic Injuries - Ärzteforum

Post#6 »

And here we go with what I predicted--sure enough somebody chimes in by
worrying about what the lawyers think...
First--I never said anything was malpractice--neither your approach nor mine
would be malpractice, as there is no data to refute your practice, and thus no
standard could be cited. Also. I did not say I automatically send these
patients home on the 2nd day.
What I did say was that there is no justification for a rote practice of
keeping someone in the hospital for a set 5-6 days as posted--I also said I do
just what you do--let the patient go home when they are ready in terms of
eating, ambulating, and no longer bleeding (the latter is clear within 24
hours)--NOT for 5-6 days or more just so they can be "watched" Pneumovax is a
reasonable option, as long as you realize it is unnecessary in 90% or more of
these cases once they pass 24 hours, and that they're liable to run a high
fever about 1-2 days later from it. Generally the patients I've watched like
this are home in 2 days, but this may vary. I agree that your routine is
reasonable and in the interests of the patient--it's also wise to explain to
the patient and document that the best course is not known--bring them into
the decision-making process
And--this is not "dogmatic"--the right word you are looking for is "empiric",
and yes, this accounts for a lot of what we do when we have to make a
judgement in the absence of clear evidence--as I also started off my post
saying--are you sure you read what I said?

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