Short-term outcomes of non-operative management of blunt splenic injury: a retrospective study

Журнал "Сеченовский вестник".  Лист редактора к этой статье можно посмотреть здесь.

Sechenov Medical Journal. Editor's checklist for this article you can find here.

РЕЦЕНЗЕНТ А / REVIEWER A

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

Scientific quality: Grade C (Fair)

Language quality: Grade B (Minor language polishing)

Re-review: Yes

For a higher level of validity of the conclusions, well-planned cohort studies, ideally randomized, are required. Non-operative management of hemodynamically stable or stabilized patients with blunt trauma of the parenchymal organs of the abdomen is

increasingly being introduced into daily practice. There are studies on the treatment of hemodynamically unstable patients, including those with penetrating abdominal wounds. The correct choice of patients for non-operative management will help to improve the treatment outcomes of patients with abdominal trauma.

In Table 3 the level of statistical significance of p is indicated in the singular, it is not entirely clear which groups it shows the difference between. It would be good to indicate the level of statistical significance of p in the groups depending on the volume of the hemoperitoneum and the severity of the organ injury.

You can also enter a p-level in Table 2 to show the statistical significance of the differences in the effective and ineffective groups of non-operative management.

Recommendation after the first round of peer-review:   minor revision.

ВТОРОЙ РАУНД РЕЦЕНЗИРОВАНИЯ /SECOND ROUND OF PEER-REVIEW

All comments have been addressed by authors.

РЕЦЕНЗЕНТ B / REVIEWER B

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

Scientific quality: Grade C (Fair)

Language quality: Grade B (Minor language polishing)

Re-review: Yes

The management of blunt splenic trauma remains highly relevant in modern emergency surgery. Given the growing trend toward organ-preserving strategies, this study is timely and addresses important clinical needs. However, it would be valuable to clarify why the Vietnamese population is of particular interest—for instance, due to high rates of road traffic accidents (especially motorcycle-related injuries), limited resources for emergency surgery, or other local factors influencing treatment protocols.

While the study does not propose fundamentally novel approaches, it provides a detailed and valuable account of a single-center experience, particularly regarding the high success rate of NOM for Grade III–IV injuries. That said, the unique factors contributing to this success (e.g., specific protocols for TAE at this institution) are not highlighted.

The study adheres to international standards, with approval from a local ethics committee and declared conflicts of interest/funding sources. For full transparency, the authors should clarify whether informed consent was obtained or state that data were collected anonymously, and consent was waived per local regulations.

The methodology (retrospective analysis, AAST grading, statistical processing in SPSS) is appropriate for the study’s aims. However, exclusion criteria for NOM (e.g., shock, peritonitis) are not specified, and technical details of TAE (embolization materials, selective vs. nonselective approach) are lacking. Including these would enhance the study’s practical relevance.

The conclusions appear overly optimistic for Grade V injuries (60% success with only five cases). A more detailed description of management in these patients is needed: Was NOM strictly applied, or did the institution’s definition include laparoscopy? Additionally, were there complications (e.g., splenic infarction, post-TAE abscesses)? This subgroup may hold the key to the study’s novelty.

Terminology aligns with accepted standards (AAST, NOM, TAE), but there are minor errors (e.g., haemoperitoneum → hemoperitoneum in Table 4).

Non-normally distributed data should be presented as medians with interquartile ranges.

Consider adding visual aids (e.g., histograms, box plots) to improve data interpretation, pending editorial approval.

The manuscript is well-structured, tables are informative, and references (2019–2022) are up-to-date and include key publications. The study may be suitable for publication after revisions.

Recommendation after the first round of peer-review:   minor revision.

ВТОРОЙ РАУНД РЕЦЕНЗИРОВАНИЯ /SECOND ROUND OF PEER-REVIEW

Thank you for your careful attention to the previous comments and for revising the manuscript. Your efforts have significantly improved the quality of the work. However, several critical aspects require further clarification to enhance scientific rigor and clarity.

The conclusions now acknowledge the limited sample size (n=5) for Grade V injuries, but data on complications (e.g., splenic infarction, abscesses) remain absent. This is crucial because Grade V injuries involve splenic artery damage. The authors mention one case of traumatic aneurysm and contrast extravasation (indicating active bleeding) in other cases, managed solely via embolization. However, embolization of the splenic artery typically reduces blood supply to the spleen, and collateral circulation via short gastric arteries is often insufficient. This may raise concerns among specialists in NOM of splenic trauma.

While the Kolmogorov-Smirnov test is mentioned in Methods, non-normally distributed data (e.g., hospital stay duration) are still presented as mean ± SD in Results.

Recommendations:

• Clarify whether complications occurred in Grade V cases. If none were observed, explain potential reasons (e.g., short follow-up period, compensated collateral circulation, as confirmed by tests).
• Consider consulting vascular or endovascular surgeons/interventional radiologists to validate the methodology and address technical nuances.
• Specify which variables had normal/non-normal distributions in Results.
• For non-normal data, replace mean ± SD with median [IQR] or Me (P25; P75)

Addressing these points will strengthen the manuscript’s validity and appeal to an international audience. Once revised, the study will be suitable for publication. Thank you for your cooperation and understanding.

РЕЦЕНЗЕНТ C / REVIEWER C

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

Scientific quality: Grade B: Good

Language quality: Grade B (Minor language polishing)

Re-review: No

The article is devoted to an urgent problem of modern life – trauma, the undisputed leader of mortality among young people. One of the causes of death in abdominal trauma is massive blood loss from damaged parenchymal organs. The spleen suffers more often than other parenchymal organs of the abdominal cavity. Therefore, timely and effective treatment of spleen injuries is extremely important to improve the treatment outcomes of injured patients.

The study included 136 patients with injured spleen who were treated in the same hospital for three years, which indicates the sufficient surgical experience of this medical institution, and the reliability of approaches used in the treatment of patients with abdominal trauma. The number of clinical cases studied is quite sufficient to determine trends and directions for further research.

The material is systematized and presented quite satisfactorily and is accessible to perception. Generally accepted tools have been selected and used for statistical processing of the obtained results, which makes it possible to interpret them correctly.

The results obtained do not pretend to be sensational, but they are modern and quite interesting. Their discussion is in the context of the results of other studies dealing with this problem and does not contradict them. The title of the article fully reflects its content.

РЕЦЕНЗЕНТ D / REVIEWER D

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

Scientific quality: Grade B: Good

Language quality: Grade B (Minor language polishing)

Re-review: No

The article should detail the principles of non-operative management in the context of blunt splenic injuries. What treatment algorithms and methodologies are recommended?

РЕКОМЕНДАЦИИ НАУЧНЫХ РЕДАКТОРОВ ЖУРНАЛА / RECOMMENDATIONS

 OF THE SCIENTIFIC EDITORS OF THE JOURNAL

Title

1. Revise the title of the manuscript to reflect the main finding or distinctive feature of your study. The current title closely mirrors that of an already published work (reference 6 in the bibliography). The title should be no more than 150 characters with spaces. Avoid abbreviations in the title.

Article highlights

1. Add the ‘Article highlights’ section that contains 3 to 5 key messages.

Aim

1. Clearly define the aim of the study. Only one aim is possible in the article. The aim should be the same both in the abstract and in the main text

Methods

1. Add inclusion, non-inclusion and exclusion criteria.
2. Provide study flowchart.
3. Provide the sample size justification, taking into account the study design, expected effect size, statistical power, and significance level.
4. Add the criterion used to assess the normality of the distribution.
5. As you perform multiple comparisons, add appropriate multiple comparison tests.

Results

1. Add p-value for each comparison in table 2.
2. Clarify the method which is used to get p-value for table 3. In the case of multiple comparisons, it is necessary to apply appropriate multiple comparison tests and report the significance level adjusted for multiple testing. Add p-value for each comparison.

Technical requirements

1. Add information about all authors (full surname and name, academic degree and title (if any), position, place of work (or study), ORCID).
2. For corresponding author provide full first and family (sur)names, abbreviated title (e.g., MD, PhD), affiliated institute’s name and complete postal address (including zip code).
3. Specify authors’ contribution.
4. Place all metadata before the main text.
5. Provide ‘List of abbreviation’ before the main text.
6. All abbreviations used in the article should be decrypted after they were firstly mentioned.
7. All abbreviations used in the tables should be defined in notes accompanying each respective table.
8. Place tables in the main text after they were firstly mentioned.