Blunt splenic trauma: Assessment, management and outcomes.

BACKGROUND: The approach for diagnosis and management of blunt splenic injury (BSI) has been considerably shifted towards non-operative management (NOM). We aimed to review the current practice for the evaluation, diagnosis and management of BSI. METHODS: A traditional narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. We used the keywords "Traumatic Splenic injury", "Blunt splenic trauma", "management" between December 1954 and November 2014. RESULTS: Most of the current guidelines support the NOM or minimally approaches in hemodynamically stable patients. Improvement in the diagnostic modalities guide the surgeons to decide the timely management pathway Though, there is an increasing shift from operative management (OM) to NOM of BSI; NOM of high grade injury is associated with a greater rate of failure, prolonged hospital stay, risk of delayed hemorrhage and transfusion-associated infections. Some cases with high grade BSI could be successfully treated conservatively, if clinically feasible, while some patients with lower grade injury might end-up with delayed splenic rupture. Therefore, the selection of treatment modalities for BSI should be governed by patient clinical presentation, surgeon's experience in addition to radiographic findings. CONCLUSION: About one-fourth of the blunt abdominal trauma accounted for BSI. A high index of clinical suspicion along with radiological diagnosis helps to identify and characterize splenic injuries with high accuracy and is useful for timely decision-making to choose between OM or NOM. Careful selection of NOM is associated with high success rate with a lower rate of morbidity and mortality.

Recreational-related head injuries in Qatar.

BACKGROUND: The incidence of recreation related-injuries (RRI) among the physically active population is increasing. This study aimed to analyse frequency and characteristics of RRI in Qatar. METHODS: A retrospective chart review was conducted for all patients with head injuries who sustained a RRI and were admitted to the trauma unit between 2008-2011. Patients' demographics, injuries, complications and mortality were analysed. RESULTS: Of 1665 cases of head injury, 107 (6.4%) had RRI. The majority of cases were males with mean age of 27 ± 12, injury severity score of 14 ± 8 and head abbreviated injury score of 3.2 ± 0.9. Mechanisms of injury included All-Terrain Vehicle, Jet-skiing, football and water-boat. Patients sustained RRI mainly had contusion followed by subarachnoid haemorrhage, subdural and epidural haematoma. Upper extremities and the chest were the most frequently associated injuries. Severe head injuries were observed in 18% of patients with Glasgow Coma Score <8. Median length of stay was 4 (1-67) days. The incidence of RRI was highest amongst Asians (66%) and nationals (23%). The overall mortality among patients with RRI was 7%. CONCLUSION: RRI causes significant morbidity and mortality. An urgent need is recommended for legislative amendment and public awareness for safety regulations during recreational activities involving potential risk of trauma.