List Archives

Thu Feb 14 06:38:08 GMT 2008

i might have mentioned this a long time ago but let me share this  
utilization review nightmare with you all. 

when we started doing nonop management in 1978 based upon angiographic  
findings, we kept all patients in the hospital until the injuries healed  
substantially on 
CT scans done TWO WEEKS apart. Longest hospitalization was about twelve  
weeks, most healed within 2-6 weeks. About 30% of patients underwent  
embolization. 

in those days in a municipal hospital, no one questioned it at all. 

Never had any rebleeds.

Sounds ridiculous but that seemed reasonable back then as an alternative to  
splenectomy. 

Thankfully reason has set in and we send our patients home in 3-5 days.,  
Don't reangio, don't CT, don't waste so much money 

sal

In a message dated 2/12/2008 7:18:38 P.M. W. Europe Standard Time,  
djinmori at terra.com.br writes:

Hi  Allen

We have been followed our non-operative management of splenic  and/or hepatic 
trauma patients since  1993. Early
phase we have "taken  care" these patients closer and we have let them out of 
their activities.  Nowadays we
allow then to return to their lives after 4 to 6 weeks just  after we check a 
new image study (sometimes US or
CT-scan)

The next  question would be: how sure we would be about splenic function?
Probably a  novell of opinions

And finally, if we are not able to confirm the  splenic function, is it 
necessary to prevent of  post-splenectomy
sepsis?

Nice case.

Surgical Emergency  Service
Hospital das Clinicas - Sao Paulo - Brazil
MD Newton Djin  Mori
djinmori at terra.com.br

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