Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization

Bansal, Samiksha; Karrer, Frederick M.; Hansen, Kristine; Partrick, David A.

doi:10.1016/j.amjsurg.2014.09.028

Cited by 44 publications

(13 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent study, Bansal and colleagues call into question the routine use of angiography and embolization for contrast blush in pediatric patients. 18 A total of 47 patients had contrast blush and there were no differences in outcomes related to splenectomy, transfusion, or failure of nonoperative care when comparing those with contrast blush with those without it. We had two pediatric patients with contrast blush who had successful embolization.…”

Section: Discussionmentioning

confidence: 90%

Nonoperative Management of the Damaged Spleen: A Community Surgeon Looks Back

Walker

2017

The American Surgeon

View full text Add to dashboard Cite

Blunt spleen injury is usually managed nonoperatively. An 8-year retrospective analysis by one community surgeon was done to provide an overview of the role of CT, angiography, and transfusion in the management algorithm. A total of 2750 patients were screened and 125 patients were identified with spleen injury. Of these 125 patients, 72 were managed without surgery. These were young (mean age 32 ± 16 years) patients with mean Injury Severity Score of 16 ± 8. Angiography was used in 14 patients. These patients received more blood (5 ± 6 vs 2 ± units of packed red blood cells) than their nonangiogram counterparts. Overall failure of nonoperative care was 3 per cent. Community surgeons can provide safe nonoperative care and current adjuncts including angi-ography may enhance splenic salvage.

show abstract

Section: Discussionmentioning

confidence: 90%

Nonoperative Management of the Damaged Spleen: A Community Surgeon Looks Back

Walker

2017

The American Surgeon

View full text Add to dashboard Cite

show abstract

“…Even though AG/AE appears to be a safe intervention, the vast majority of retrospective observational data show that very few pediatric patients with contrast extravasation may benefit from embolization [ 153 , 181 ].…”

Section: Pediatric Patientsmentioning

confidence: 99%

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

et al. 2017

View full text Add to dashboard Cite

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

show abstract

“…However, it remains a high-risk factor for failure of NOM for SOI. [13][14][15][16][17][18][19][20][21][22][23][24][25] However, Diamond et al; reported that nearly half of patients may not need any interventions especially in the retroperitoneum and the pelvis areas regardless of the size or volume of the bleed. 26,27 Selection of embolic agents in trauma patients is guided by the size of the vessels to be occluded and permanence of the desired occlusion.…”

Section: Discussionmentioning

confidence: 99%

Utility of Angioembolization in Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis from a Level 1 Trauma Center

Al-Thani

Abdelrahman

Barah

et al. 2021

TCRM

View full text Add to dashboard Cite

Background: Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical and/or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center. Methods: We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients' data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry. Results: A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury, 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of the patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock index and more blood transfusion. Absorbable particles (Gelfoam) were the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95%, respectively, with low rebleeding and complication rates. The hospital and ICU length of stay were 13 and 6 days, respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%. Conclusion:Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.

show abstract

Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization

Cited by 44 publications

References 21 publications

Nonoperative Management of the Damaged Spleen: A Community Surgeon Looks Back

Nonoperative Management of the Damaged Spleen: A Community Surgeon Looks Back

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

Utility of Angioembolization in Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis from a Level 1 Trauma Center

Contact Info

Product

Resources

About