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Mont-Saint-Éloi, France

Brault-Noble G.,Montpellier University | Charbit J.,Montpellier University | Chardon P.,Montpellier University | Barral L.,Montpellier University | And 4 more authors.
Journal of Trauma and Acute Care Surgery | Year: 2012

BACKGROUND: A strategy of prophylactic splenic angioembolization using observation failure risk (OFR) computed tomographic (CT) scan criteria has been proposed recently. The main aim of the present study was to evaluate the relevance of the criteria in terms of delayed splenic rupture in patients with blunt splenic injury. METHODS: All patients with blunt splenic injuries admitted consecutively between January 2005 and January 2010 to our institution were included. Clinical, CT scan, and angiographic data, initial management, and outcome were noted. Patients managed expectantly were classified according to OFR CT scan criteria (high OFR was defined by at least one of the following CT scan signs: blush, pseudoaneurysm, Organ Injury Scale [OIS] grade III with a large hemoperitoneum, and OIS grade IV or 5). Initial management success was especially studied. RESULTS: Among the 208 patients included, 161 (77%) were treated by observation (35 OIS grade I, 64 OIS grade II, 33 OIS grade III, 18 OIS grade IV, and 11 OIS grade V) and 129 (80%) were men, with a mean (SD) age of 36.1 (18.7) years and a mean (SD) Injury Severity Score of 20.8 (15.4). Forty-nine patients (30%) had high OFR CT scan criteria. Thirteen patients (8%) experienced observation failure. High OFR CT scan criteria (odds ratio, 11; 95% confidence interval, 2.5-47.5) and patients 50 years and older (odds ratio, 33.9; 95% confidence interval, 6.2-185.5) were independent factors related to observation failure. The positive predictive value of OFR CT scan criteria for observation failure was 18%, and the negative predictive value was 96%. The corresponding values were 67% and 90%, respectively, in patients 50 years and older and 3% and 99%, respectively, in patients younger than 50 years. CONCLUSION: OFR CT scan criteria lack specificity to predict observation failure, mainly in patients younger than 50 years. Age should be considered when identifying patients requiring prophylactic splenic angioembolization. LEVEL OF EVIDENCE: Diagnostic study, level III. © 2012 Lippincott Williams & Wilkins. Source


Jung B.,Montpellier University | Nougaret S.,Montpellier University | Chanques G.,Saint Eloi University Hospital | Mercier G.,Montpellier University Hospital Center | And 5 more authors.
Anesthesiology | Year: 2011

Background: Assessment and management of septic shock associated adrenal function remain controversial. The aim of this study was to explore the prognostic value of adrenal gland volume in adults with septic shock. Methods: A short cosyntropin test and determination of adrenal volume by computed tomography were performed within 48 h of shock in patients with septic shock (n = 184) and in 2 control groups: 40 ambulatory patients and 15 nonseptic critically ill patients. The primary endpoint was intensive care unit mortality. Results: At intensive care unit discharge, 59 patients with septic shock died. Adrenal volume was 12.5 cm3 [95% CI, 11.3-13.3] and 8 cm3 [95% CI, 6.8-10.1] in the nonseptic group (P < 0.05 with both septic cohorts) and 7.2 cm [95%CI, 6.3-8.5] in the ambulatory patient group (P < 0.05 in patients with septic shock). In patients with septic shock, adrenal volume less than 10 cm3 was associated with higher 28-day mortality rates with an area under the receiver operating curve of 0.84 [95% CI, 0.78-0.89]. Adrenal volume above 10 cm3 was an independent predictor of intensive care unit survival (hazard ratio = 0.014; 95% CI [0.004-0.335]). Conclusion: A total adrenal gland volume less than 10 cm3 during septic shock was associated in univariate and multivariate analysis with mortality at day 28 in patients with septic shock. Whether adrenal gland volume can be a surrogate of adrenal gland function and used to guide hydrocortisone therapy in septic shock patients needs to be further investigated. Copyright © 2011, the American Society of Anesthesiologists, Inc. Source

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