David Wesson
13 statements · 1 topic · summaries given as host listed separately
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CT scans became more prevalent, leading to a grading system for splenic injuries and a treatment algorithm based on CT gradings, but in the last 10 years the approach has flipped to prioritize clinical assessment over CT grade.
clinical ·
Splenic Injury
Non-believers said the radionuclide scans in Dr. Wesson's 1980 series were congenital anomalies, so Dr. Wesson's team did follow-up radionuclide scans showing healing and resolution of the defect as proof of traumatic injury.
clinical ·
Splenic Injury
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David's statements about Splenic Injury 13 statements
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History Of Non Operative Management for Splenic Injury with Dr. Wesson
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In 1909, Dr. Coker wrote that if the spleen is injured it should be removed, and that was the only treatment.
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In 1968, Dr. Jimmy Simpson published the first series of non-operative management of splenic injuries in what is now the Journal of the American College of Surgeons; it was a case series of only 50 patients with a small percentage managed non-operatively.
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In the 1960s and 1970s there was no way to prove splenic injury because imaging was not available, so skeptics didn't believe Dr. Simpson's experience and didn't change their practice.
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In 1980, Dr. Wesson presented a case series titled 'Ruptured Spleen, when to operate' at the American Academy of Pediatrics pediatric surgical section in Detroit, and all patients had diagnostic imaging, the majority being radionuclide spleen scans.
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At an American College of Surgeons meeting in Florida, Dr. William Blaisdell told Dr. Wesson that if you believe surgery aggravates bleeding you shouldn't be in surgery, and that adult trauma surgeons have more experience managing kids than any pediatric surgeon will ever see because pediatric surgeons don't see that much.
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Non-believers said the radionuclide scans in Dr. Wesson's 1980 series were congenital anomalies, so Dr. Wesson's team did follow-up radionuclide scans showing healing and resolution of the defect as proof of traumatic injury.
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Adult trauma surgeons thought non-operative management of splenic injuries was complete baloney, but pediatric surgeons were more open-minded to the practice change.
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After the 1980 presentation, all the talk was about resource utilization and length of stay, and the hook was that these patients would have better outcomes if managed non-operatively, which got the attention of the rest of the surgical world.
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Non-operative management of the spleen put pediatric surgeons in the limelight, and adult trauma surgeons at adult trauma meetings credit pediatric surgeons for starting this trend that is now the norm.
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APSA made standardized guidelines so institutions could manage splenic injuries in a similar way and group outcomes across the country to assess results.
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CT scans became more prevalent, leading to a grading system for splenic injuries and a treatment algorithm based on CT gradings, but in the last 10 years the approach has flipped to prioritize clinical assessment over CT grade.
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Summaries David gave as host · 2 summaries
Recaps of other experts' statements, not David's own clinical position.
Summaries David gave as host · Splenic Injury 2 summaries
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History Of Non Operative Management for Splenic Injury with Dr. Wesson
Host summary
David Wesson summarizing a resource: If the spleen is injured, it should be removed, and that was the only treatment for it.
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Host summary
David Wesson summarizing a resource: Blaisdell said, if you believe surgery aggravates bleeding, then you shouldn't be in surgery. We probably have more experience in managing kids than any pediatric surgeon will ever see, because they don't see that much.
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