Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study
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To review the management of patients >16 years with blunt splenic injury in a single, UK, major trauma centre and identify whether the following are associated with success or failure of non-operative management with selective use of arterial embolization (NOM ± AE): age, Injury Severity Score (ISS), head injury, haemodynamic instability, massive transfusion, radiological hard signs [contrast extravasation or pseudoaneurysm on the initial computed tomography (CT) scan], grade, and presence of intraparenchymal haematoma or splenic laceration.
Retrospective, cross-sectional study undertaken between April 2012 and October 2015. Paediatric patients, penetrating splenic trauma, and iatrogenic injuries were excluded. Follow-up was for at least 30 days.
154 patients were included. Median age was 38 years, 77.3% were male, and median ISS was 22. 14/87 (16.1%) patients re-bled following NOM in a median of 2.3 days (IQR 0.8–3.6 days). 8/28 (28.6%) patients re-bled following AE in a median of 2.0 days (IQR 1.3–3.7 days). Grade III–V injuries are a significant predictor of the failure of NOM ± AE (OR 15.6, 95% CI 3.1–78.9, p = 0.001). No grade I injuries and only 3.3% grade II injuries re-bled following NOM ± AE. Age ≥55 years, ISS, radiological hard signs, and haemodynamic instability are not significant predictors of the failure of NOM ± AE, but an intraparenchymal or subcapsular haematoma increases the likelihood of failure 11-fold (OR 10.9, 95% CI 2.2–55.1, p = 0.004).
Higher grade injuries (III–V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM ± AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24 h with appropriate advice.
KeywordsSpleen Splenic Blunt Embolization Non-operative management
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
For this type of study, formal consent is not required.
Previous presentation of this work
European Society of Trauma and Emergency Surgery Congress, Vienna 2016 oral presentation. Reference 0197: Management of Blunt Splenic Injury: a retrospective review of practice and outcomes at a UK major trauma centre.
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