There was no grant funding or other financial support involved in this study. The original founders of the CRASH trial had no role in this study design, data collection and analysis, decision to publish, or preparation of the manuscript. The original funding for the CRASH-1 trial was obtained from the UK Medical Research Council.
Competing interests There are no financial, personal or professional interests that could be construed to have Influenced this paper. Authors’ contributions SS, PP, and IR conceived the study. SS and PP created the statistical analysis plan and analyzed the data. EK provided key insight Inhibitors,research,lifescience,medical in creating an accessible and user-friendly risk score. SS drafted the manuscript, and all authors contributed substantially to its revision. Pre-publication history Inhibitors,research,lifescience,medical The pre-publication history
for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/12/17/prepub
We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying Belinostat HDAC disease and 112 of which occurred Inhibitors,research,lifescience,medical following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were www.selleckchem.com/products/BIBF1120.html implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its Inhibitors,research,lifescience,medical complications in 38 cases. The most common associated diseases were infectious (n=143), haematologic (n=84) and non-haematologic neoplasms (n=48). Amyloidosis (n=24), internal trauma such as cough or vomiting (n=17) and
rheumatologic diseases (n=10) are less frequently reported. Colonoscopy (n=87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n=6), infarction (n=6) and hamartomata (n=5). Medications associated with rupture include anticoagulants (n=21), thrombolytics (n=13) and recombinant G-CSF (n=10). Other causes or associations reported very infrequently Inhibitors,research,lifescience,medical include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher’s disease, Brefeldin_A Wilson’s disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. Conclusions Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.