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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03231202
Registration number
NCT03231202
Ethics application status
Date submitted
5/07/2017
Date registered
27/07/2017
Titles & IDs
Public title
Splenic Injury Embolization - the Question About NOM (SInE Qua NOM)
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Scientific title
A Multi-centre, Prospective, Randomized Controlled Study to Compare Outcomes of Non-operative Management (NOM) With and Without Splenic Arterial Embolization (SAE) in Hemodynamically Stable OIS Grade 4 and 5 Splenic Injuries.
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Secondary ID [1]
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2016/15608
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Wounds and Injuries
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Condition category
Condition code
Skin
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0
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Other skin conditions
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Surgery - Embolization
Experimental: Embolization - The intervention arm will perform SAE as a central embolization of the splenic artery.
Additional peripheral embolization is left to the discretion of the interventional radiologist.
The study does not interfere with local diagnostic work-up and treatment protocols.
No intervention: Observation - The control arm in this randomized controlled trial will include only NOM patients diagnosed with splenic injuries OIS grade 4 or 5 and suitable for observation alone, and will comprise clinical observation according to local routines and protocols.
Treatment: Surgery: Embolization
The intervention arm will perform SAE as a central embolization of the splenic artery.
Additional peripheral embolization is left to the discretion of the interventional radiologist.
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Intervention code [1]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Failure of NOM
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Assessment method [1]
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The primary objective is to compare the failure rate due to splenic bleeding between the patients undergoing pre-emptive SAE as part of NOM and the patients not undergoing SAE. The primary endpoint is the proportion of subjects failing NOM due to spleen related bleeding within 7 days of injury. All analyses will be based on an intention to treat analysis.
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Timepoint [1]
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7 days
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Secondary outcome [1]
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Delayed bleeding episode
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Assessment method [1]
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Incidence. Delayed bleeding episode is defined as hemodynamically unstable patient, CT verified contrast blush or drop in hemoglobin/hematocrit.
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Timepoint [1]
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6-12 weeks
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Secondary outcome [2]
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All cause and spleen related mortality
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Assessment method [2]
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Incidence
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Timepoint [2]
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6-12 weeks
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Secondary outcome [3]
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All cause and spleen related failure of NOM
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Assessment method [3]
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Incidence
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Timepoint [3]
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6-12 weeks
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Secondary outcome [4]
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Pseudoaneurysms (PSA)
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Assessment method [4]
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Incidence
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Timepoint [4]
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6-12 weeks
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Secondary outcome [5]
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Symptomatic thromboembolic events
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Assessment method [5]
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Incidence
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Timepoint [5]
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6-12 weeks
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Secondary outcome [6]
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Other spleen related complications
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Assessment method [6]
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Incidence
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Timepoint [6]
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6-12 weeks
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Secondary outcome [7]
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Angiography related complications
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Assessment method [7]
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Incidence
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Timepoint [7]
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6-12 weeks
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Eligibility
Key inclusion criteria
* blunt splenic injury OIS grade 4 or 5
* Adult trauma patients (according to local definitions)
* Present hemodynamically normal as judged by the responsible trauma consultant surgeon and eligible for NOM
* Randomised within 48 hours of injury
* Written informed consent is obtained
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Minimum age
16
Years
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Maximum age
80
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Hemodynamically compromised (not suitable for NOM)
* Needing transfusions
* CT shows evidence of significant contrast extravasation
* Other indications for laparotomy
* Prisoners
* Pregnant
* >80 years old
* Penetrating injury
* Contraindication to iv contrast
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
UNKNOWN
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/07/2017
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/08/2019
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Actual
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Sample size
Target
224
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment hospital [1]
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Liverpool Hospital - Sydney
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Recruitment postcode(s) [1]
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- Sydney
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Recruitment outside Australia
Country [1]
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United States of America
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State/province [1]
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Colorado
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Country [2]
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United States of America
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State/province [2]
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Pennsylvania
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Country [3]
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United States of America
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State/province [3]
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Washington
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Country [4]
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Canada
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State/province [4]
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Montreal
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Country [5]
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Denmark
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State/province [5]
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Copenhagen
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Country [6]
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Germany
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State/province [6]
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Cologne
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Country [7]
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Netherlands
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State/province [7]
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Utrecht
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Country [8]
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Norway
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State/province [8]
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Oslo
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Country [9]
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Sweden
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State/province [9]
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Stockholm
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Country [10]
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United Kingdom
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State/province [10]
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London
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Country [11]
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United Kingdom
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State/province [11]
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Nottingham
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Funding & Sponsors
Primary sponsor type
Other
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Name
Oslo University Hospital
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
The primary objective is to compare the failure rate due to splenic bleeding between the patients undergoing pre-emptive splenic arterial embolization (SAE) as part of non-operative management (NOM) and the patients not undergoing SAE. We hypothesize that the use of pre-emptive SAE will decrease the delayed bleeding rate and increase the success rate of NOM.
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Trial website
https://clinicaltrials.gov/study/NCT03231202
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Trial related presentations / publications
Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, Schuster KM, Seamon MJ, Tchorz KM, Zarzuar BL, Kerwin AJ; Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S294-300. doi: 10.1097/TA.0b013e3182702afc. Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, Crookes BA, Harrington DT, Gregg SC, Brotman S, Burke PA, Davis KA, Gupta R, Winchell RJ, Desjardins S, Alouidor R, Gross RI, Rosenblatt MS, Schulz JT, Chang Y. Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Arch Surg. 2010 May;145(5):456-60. doi: 10.1001/archsurg.2010.58. Davis KA, Fabian TC, Croce MA, Gavant ML, Flick PA, Minard G, Kudsk KA, Pritchard FE. Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma. 1998 Jun;44(6):1008-13; discussion 1013-5. doi: 10.1097/00005373-199806000-00013. Schurr MJ, Fabian TC, Gavant M, Croce MA, Kudsk KA, Minard G, Woodman G, Pritchard FE. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma. 1995 Sep;39(3):507-12; discussion 512-3. doi: 10.1097/00005373-199509000-00018. McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg. 2005 Jun;140(6):563-8; discussion 568-9. doi: 10.1001/archsurg.140.6.563. Sclafani SJ, Weisberg A, Scalea TM, Phillips TF, Duncan AO. Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery. Radiology. 1991 Oct;181(1):189-96. doi: 10.1148/radiology.181.1.1887032. Miller PR, Chang MC, Hoth JJ, Mowery NT, Hildreth AN, Martin RS, Holmes JH, Meredith JW, Requarth JA. Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved. J Am Coll Surg. 2014 Apr;218(4):644-8. doi: 10.1016/j.jamcollsurg.2014.01.040. Epub 2014 Jan 28. Bhullar IS, Frykberg ER, Siragusa D, Chesire D, Paul J, Tepas JJ 3rd, Kerwin AJ. Selective angiographic embolization of blunt splenic traumatic injuries in adults decreases failure rate of nonoperative management. J Trauma Acute Care Surg. 2012 May;72(5):1127-34. doi: 10.1097/TA.0b013e3182569849. Schimmer JA, van der Steeg AF, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: A systematic review. Injury. 2016 Mar;47(3):525-30. doi: 10.1016/j.injury.2015.10.047. Epub 2015 Nov 19. Haan JM, Bochicchio GV, Kramer N, Scalea TM. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 2005 Mar;58(3):492-8. doi: 10.1097/01.ta.0000154575.49388.74. Skattum J, Titze TL, Dormagen JB, Aaberge IS, Bechensteen AG, Gaarder PI, Gaarder C, Heier HE, Naess PA. Preserved splenic function after angioembolisation of high grade injury. Injury. 2012 Jan;43(1):62-6. doi: 10.1016/j.injury.2010.06.028. Epub 2010 Jul 31. Peitzman AB, Harbrecht BG, Rivera L, Heil B; Eastern Association for the Surgery of Trauma Multiinstitutional Trials Workgroup. Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg. 2005 Aug;201(2):179-87. doi: 10.1016/j.jamcollsurg.2005.03.037. Cirocchi R, Boselli C, Corsi A, Farinella E, Listorti C, Trastulli S, Renzi C, Desiderio J, Santoro A, Cagini L, Parisi A, Redler A, Noya G, Fingerhut A. Is non-operative management safe and effective for all splenic blunt trauma? A systematic review. Crit Care. 2013 Sep 3;17(5):R185. doi: 10.1186/cc12868. Zarzaur BL, Vashi S, Magnotti LJ, Croce MA, Fabian TC. The real risk of splenectomy after discharge home following nonoperative management of blunt splenic injury. J Trauma. 2009 Jun;66(6):1531-6; discussion 1536-8. doi: 10.1097/TA.0b013e3181a4ed11. Clancy AA, Tiruta C, Ashman D, Ball CG, Kirkpatrick AW. The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007. J Trauma Manag Outcomes. 2012 Mar 13;6(1):4. doi: 10.1186/1752-2897-6-4.
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Public notes
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Contacts
Principal investigator
Name
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Christine Gaarder, MD, PhD
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Address
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Head, Department of Traumatology
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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iver Anders Gaski, MD
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Address
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Country
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Phone
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90063971
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Type
Citations or Other Details
Journal
Stassen NA, Bhullar I, Cheng JD, Crandall ML, Frie...
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More Details
]
Journal
Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hu...
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More Details
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Journal
Davis KA, Fabian TC, Croce MA, Gavant ML, Flick PA...
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Journal
Schurr MJ, Fabian TC, Gavant M, Croce MA, Kudsk KA...
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McIntyre LK, Schiff M, Jurkovich GJ. Failure of no...
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More Details
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Sclafani SJ, Weisberg A, Scalea TM, Phillips TF, D...
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More Details
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Miller PR, Chang MC, Hoth JJ, Mowery NT, Hildreth ...
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Bhullar IS, Frykberg ER, Siragusa D, Chesire D, Pa...
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Schimmer JA, van der Steeg AF, Zuidema WP. Splenic...
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More Details
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Haan JM, Bochicchio GV, Kramer N, Scalea TM. Nonop...
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Skattum J, Titze TL, Dormagen JB, Aaberge IS, Bech...
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Journal
Peitzman AB, Harbrecht BG, Rivera L, Heil B; Easte...
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More Details
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Journal
Cirocchi R, Boselli C, Corsi A, Farinella E, Listo...
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More Details
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Journal
Zarzaur BL, Vashi S, Magnotti LJ, Croce MA, Fabian...
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More Details
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Journal
Clancy AA, Tiruta C, Ashman D, Ball CG, Kirkpatric...
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More Details
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Results not provided in
https://clinicaltrials.gov/study/NCT03231202