The Efficacy of World Society of Emergency Surgery Classification in the Management of Splenic Injury: An Observational study

INTRODUCTION: • The spleen is the most frequently damaged organ in trauma to the abdomen of any cause • An unrecognized splenic injury is a very preventable cause of severe hypovolemic shock and traumatic death • It is the most vascular organ in the body, hence bleeding from splenic injuries is arterial, and can cause significant hemoperitoneum. Bleeds from the spleen are mainly intraperitoneal. • Any lower left chest or upper left abdominal trauma has the propensity to carry the risk of injury to the spleen. It is highly vulnerable to injury during trauma due to its juxtaposition in tge left upper abdomen to the 9th, 10th and 11th ribs. The trauma can be penetrating, blunt, or indirect trauma (tear in the splenic capsule during traction exerted on the splenocolic ligament) • The spleen is a very important organ in terms of its function in the immunity process, and lymphopoeisis. The normal splenic function is essential for carrying out opsonisation of encapsulated organisms and in the subsequent immune response mounted by the body against them. AIMS AND OBJECTIVES: Primary objective: To assess the efficacy of the WSES (World society of Emergency surgery) classification in becoming a heralded standard algorithm for the management of splenic injury. Secondary objective: To assess effect on patient morbidity and mortality following the use of this algorithm To employ the WSES classification in order to: - Categorize patients suffering from splenic injury - Guide the management of said patients as per the category they are placed under - To assess the morbidity and mortality data. MATERIALS AND METHODS: Sample size : 65 cases. Study design : Observational study (Prospective & Retrospective). Study population : 65 cases. Study period : August 2021 to August 2022 (1 year). Study Centre : Institute of General Sugery, Madras Medical College, Rajiv Gandhi Government General hospital, Chennai SUBJECT SELECTION: Inclusion criteria: 1. Age more than 15 years. 2. Patients of blunt trauma to the abdomen. Exclusion criteria: 1. Paediatric population (age less than 15 years). 2. Patients who died before complete diagnostic workup. 3. Patients with penetrating trauma to the abdomen. RESULTS: The data collected during the study was formulated into a master chart in Microsoft office excel and statistical analysis was done with help of computer using statistical software package SPSS V.21 for windows. Using this software, frequencies, range, mean, standard deviation and ‘p’ value were calculated through independent sample ‘t’ test and also univariate analysis was done using chi square test to find out the association between the variables. p value of < 0.05 was taken as statistically significant. CONCLUSION: The aim of this study was to suggest the WSES classification as a standard in trauma centers for the stratification of splenic injuries and their subsequent management. From the results of the study discussed above, it can be inferred that age of the patient, systolic blood pressure at arrival, number of packed cells transfused, AAST grade, as well as the WSES category were all influencers of the ultimate outcome of the patient and the success of whichever line of management was decided upon in the emergency room. It can be said with a degree of confidence that in the present day, the failure of non-operative management has drastically reduced and that it is no longer associated only to the AAST grade of the lesion. The physiopathological status of the patient, rather than the anatomy of the splenic injury, should guide the therapeutic decision making. From the study, it is learnt that all the factors that related to operative management and failure of non-operative management were in relation to the physiopathological status of the patient rather than the anatomy. This brings the WSES classification to the forefront, as it considers the physiological parameters from the beginning, and hence influences the stratification of patients differently. The current school of thought is to embrace non-operative management rather than perform rampant splenectomies, and in order to avoid unnecessary surgery, it is imperative to know what to do for which patient as a standard protocol that can be employed by all trauma centers with adequate facilities to undertake non-operative management. According to our study, WSES IV represents the only factor related to proceeding with operative management immediately, thus proving that the hemodynamic status is the only determinant of the necessity to proceed to the operating room. The large-scale application of the WSES classification has the potential to realistically increase the rate of non-operative management and improve and standardize management of splenic injury. It also allows to reduce the rate of splenectomy and thus improve the short and long-term survival of the patient