American Society of Emergency Radiology Multicenter Blunt Splenic                    Trauma Study: CT and Clinical Findings

Lee, James T.; Slade, Emily; Uyeda, Jennifer W.; Steenburg, Scott D.; Chong, Suzanne T.; Tsai, Richard; Raptis, Demetrios A.; Linnau, Ken F.; Chinapuvvula, Naga Ramesh; Dattwyler, Matthew; Dugan, Adam; Baghdanian, Arthur H.; Flink, Carl; Baghdanian, Armonde; LeBedis, Christina A.

doi:10.1148/radiol.2021202917

Cited by 16 publications

(7 citation statements)

References 30 publications

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“…17 Another finding of this study was that the utilization of splenic angioembolization was increased with time, and the rate was raised from 12.0% to 22.0% between 2004-2006 and 2014-2016. Similar trends were reported from level 1 trauma centers in the United States 6 and Taiwan. 18 Similar to Taiwan, 18 the top 25% of institutions participating in the JTDB were tertiary, well-equipped, emergency hospitals.…”

Section: Interpretation Of the Present Findingssupporting

confidence: 81%

“… 4 Previous studies reported that approximately 80%–90% of patients with splenic injury could be treated by NOM. 5 , 6 Angioembolization is used with NOM for the treatment of adult blunt splenic injuries in adults, and its utilization has been increasing. 6 Moreover, recent guidelines recommended its use in hemodynamically stable patients with contrast blush.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Angioembolization is used with NOM for the treatment of adult blunt splenic injuries in adults, and its utilization has been increasing. 6 Moreover, recent guidelines recommended its use in hemodynamically stable patients with contrast blush. 7 Substantial variations in the utilization of angioembolization have been reported internationally.…”

Section: Introductionmentioning

confidence: 99%

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Variation in the utilization of angioembolization for splenic injury in hospitals: a nationwide cross‐sectional study in Japan

Aoki

Abe

Hagiwara

et al. 2023

Acute Medicine & Surgery

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Aim Substantial variations in the utilization of angioembolization have been reported internationally. However, the existence of variations in the utilization of angioembolization in Japan is currently unknown. Methods This was a cross‐sectional study using data from a nationwide trauma registry in Japan. Of the 4,896 registered adult patients with splenic injury, we investigated 3,319 patients in the top 25% of the hospitals that registered the highest number of splenic injury patients in the Japan Trauma Data Bank. The primary outcome of this study was initial angioembolization. We calculated the expected initial angioembolization rates using multiple regression analysis adjusted for patient factors. In addition, we evaluated the range of observed‐to‐expected initial splenic angioembolization ratio for each hospital. Moreover, we assessed whether this ratio was increased with time. Results The frequency of initial splenic angioembolization ranged from 0% to 52%. The median expected initial angioembolization rate, calculated through multiple logistic regression analysis, was 19.7%. The observed‐to‐expected initial splenic angioembolization ratio for each hospital ranged from 0 to 2.36. The observed initial angioembolization rate tended to increase with time ( P < 0.001). Conclusions Despite adjustment for patient factors, substantial variations were observed in the utilization of splenic angioembolization among hospitals in Japan.

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Section: Interpretation Of the Present Findingssupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variation in the utilization of angioembolization for splenic injury in hospitals: a nationwide cross‐sectional study in Japan

Aoki

Abe

Hagiwara

et al. 2023

Acute Medicine & Surgery

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“…Additionally, injury to the spleen was also the most detected post-DCL CT finding with a total of 36 instances. These findings are unsurprising as the spleen is the most injured organ after blunt trauma and that, in recent years, vascular injuries to the spleen related to blunt trauma are being identified at increasingly higher rates (25,26). The most common intraoperative finding, however, was injury to the bowel/mesentery with a total of 55 instances.…”

Section: Discussionmentioning

confidence: 99%

Single Center Retrospective Review of Post-laparotomy CT Abdomen and Pelvis Findings and Trends

et al. 2022

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PurposeTo identify common findings visualized on CT following damage control laparotomy, including post-surgical changes and additional injuries, and to determine change in frequency of post-laparotomy CT at our institution over time.MethodsSingle institution, IRB-Exempt, retrospective review of the University of Kentucky trauma registry from 1/2006 to 2/2019 for all trauma patients undergoing exploratory laparotomy initially and subsequently undergoing CT of the abdomen and pelvis within 24 hours. Operative findings from surgical operation notes and findings reported on post-laparotomy CT were recorded, including vascular and solid organ injuries, operative changes, free intraperitoneal fluid/air, and retroperitoneal findings. Next steps in management were also recorded.ResultsIn total 1,047 patients underwent exploratory laparotomy initially at our institution between 1/2006-2/2019. Of those, only 96 had a diagnostic CT of the abdomen and pelvis within 24 h after initial surgery, first occurring in 2010. Among these 96, there were 71 blunt and 25 penetrating injuries. Most common injuries recognized during exploratory laparotomy were bowel/mesentery (55), spleen (34), and liver (26). Regarding CT findings, all patients (96/96, 100%) had residual pneumoperitoneum, 84/96 (87.5%) had residual hemoperitoneum, 36/96 (37.5%) noted post-surgical changes or additional injuries to the spleen, 36/96 (37.5%) to the bowel/mesentery, and 32/96 (33.3%) to the liver, and 34/96 (35.4%) were noted to have pelvic fractures. After CT, 31/96 (32.3%) went back to the OR for relook laparotomy and additional surgical intervention and 7/96 (7.3%) went to IR for embolization. Most common procedures during relaparotomy involved the bowel (8) and solid organs (6).ConclusionsCT examination within 24 h post damage control laparotomy was exceedingly rare at our institution prior to 2012 but has steadily increased. Frequency now averages 20.5% yearly. Damage control laparotomy is an uncommon clinical scenario; however, knowledge of frequent injuries and common post-operative changes will aid in radiologist detection of additional injuries helping shape next step management and provide adequate therapy.

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“…The imaging protocol we suggest in the CT follow-up is a multiphasic CT protocol [ 10 , 11 , 12 ], the same adopted at the admission, as new lesions may manifest in the meantime, especially vascular, and so it is important to have all the data useful to orient the treatment ( Figure 2 ) [ 10 , 11 , 13 , 14 ].…”

Section: Computed Tomography (Ct)mentioning

confidence: 99%

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

et al. 2023

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In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

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American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings

Cited by 16 publications

References 30 publications

Variation in the utilization of angioembolization for splenic injury in hospitals: a nationwide cross‐sectional study in Japan

Variation in the utilization of angioembolization for splenic injury in hospitals: a nationwide cross‐sectional study in Japan

Single Center Retrospective Review of Post-laparotomy CT Abdomen and Pelvis Findings and Trends

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

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