Interventional Radiology service provision and practice for the management of traumatic splenic injury across the Regional Trauma Networks of England

Hughes, Jane; Scrimshire, Ashley B; Steinberg, Laura J.; Yiannoullou, Petros; Newton, Katherine; Hall, Claire; Pearce, Lyndsay; Macdonald, A. D H

doi:10.1016/j.injury.2017.02.031

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…The overall rate of complications in this study was low at 5.6% and occurred at a median time of 2.1 days after the treatment. In addition, only 3% of patients proceeded to splenectomy at a median time of 4 days which is low, and in keeping with the rate shown in prior literature (Moore et al 1989;Schnüriger et al 2011;Davies and Wells 2019;Hughes et al 2017). Of the 7 patients requiring splenectomy after embolization, 1 patient was a 30-year-old male who presented after a motor vehicle accident with multiple injuries (ISS 38) including grade V splenic injury, hollow viscus injury, and pelvic bleeding on CT scan.…”

Section: Discussionsupporting

confidence: 72%

SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study

et al. 2020

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Background As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma center using the 2018 update to the AAST criteria, and further sub-stratify the role of angiography in AAST grade III injuries with significant hemoperitoneum. All patients between 1 January 2009 and 1 January 2019 who underwent blunt trauma and proceeded to embolization were included. Data was collected concerning initial injury grade, location of embolization, type of embolic material used, complications, and need for subsequent splenectomy. Technical success was defined as successful angiographic occlusion of the target artery at the conclusion of embolization. Clinical success was defined as splenic salvage at discharge. Vascular lesions were characterized including those with active bleeding, pseudoaneurysm, and arterio-venous fistula. Results Two hundred thirty-two patients were included in the study. Treatments were performed at a median of 0 days (range 0–28 days) and the median AAST grade was IV (range III-V). Technical success was achieved in all patients. There were 13 complications (5.6%) consisting of re-bleed (9, 3.9%), infarction (3, 1.3%), and access site haematoma (1, 0.43%). Clinical success was achieved in 97% of patients with 7 patients requiring splenectomy after SAE (3.0%) at a median time of 4 days (range 0–17 days). Angiography in patients with grade III injuries identified 18 occult vascular injuries not identified at initial CT (p < 0.0001). Conclusions The SPLEEN-IN study shows that treatment of intermediate-high grade blunt force traumatic splenic injuries using SAE resulted in a low rate of complication and splenic salvage in 97% of patients, providing a safe and effective treatment in stable patients. In addition, angiography of grade III injuries identified occult vascular lesions and may warrant treatment of select patients in this cohort. Level of evidence Level 3.

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Section: Discussionsupporting

confidence: 72%

SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study

et al. 2020

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“…Furthermore, several institutions have expanded the indication of TAE to relatively unstable patients, based on advanced techniques and improved access to IVR. 16 However, it should be noted that using NOM with TAE is based on the precise detection of hemorrhage sites by a contrast blush on CT. 17,18 Therefore, the development of the technology and availability of CT and IVR can be key components in the future innovation of trauma care.…”

mentioning

confidence: 99%

The Survival Benefit of a Novel Trauma Workflow that Includes Immediate Whole-body Computed Tomography, Surgery, and Interventional Radiology, All in One Trauma Resuscitation Room

et al. 2019

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This novel trauma workflow, comprising immediate CT diagnosis and rapid bleeding control without patient transfer, as realized in the Hybrid ER, may improve mortality in severe trauma.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.

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“…As mentioned before, one of the most dangerous life-threatening hemorrhagic events and considered to be a kind of surgical disease is trauma. In the process of care management of trauma patients who are not stable hemodynamically, the medical technique of interventional radiology (IR) could be applied as a useful non-operative procedure for the management of trauma patients, especially in the cutting-edge trauma care system [68].…”

Section: The Novel System Of Hybrid Emergency Roommentioning

confidence: 99%

A Review of Assessment and Treatment of Trauma in Emergency Department

2020

jcr

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Background:Traumatic injuries are the major destructive causes of human disability and in some situations, they could cause mortality. Preparing an appropriate procedure for the management and treatment of trauma patients is still a big challenge. Anyway, through immediate diagnosis and management of trauma patients in emergency departments mainly in trauma golden hour most appropriate outcomes could be achieved. The initial examination of trauma patients should be carried out in the trauma golden hour by most appropriate diagnosis equipment prepared in the emergency trauma care unit. Objective:The present study was performed for reviewing the most appropriate techniques and equipment of diagnosis and management of traumatic injuries. Material and Method:For obtaining the most appropriate outcomes, a comprehensive review carried out through the general medical databases of PubMed, Embase, Google Scholar, MEDLINE, databases of Cochrane Library, Allied and Complementary Medicine Database and Allied Health Literature of CINAHL on care system of patients who suffer from various kinds of trauma were searched up to March 2020. Finally, the total number of 73 articles were selected for reviewing the newest available data around the main objective of the present study. Results:Trauma patients who detected with serious injuries in their vital organs should be managed through an appropriate standardized guideline. This comprehensive guideline is categorized into fourteen critical steps that provide general information about the importance, objective, initial actions, required equipment and staff and also the overall knowledge of any step in diagnosis and management of trauma patients. Conclusion:The prepared comprehensive guideline for appropriate management of trauma patients is a precise effective method for immediate management of trauma patients in trauma care units of emergency departments. The most critical situation such as severely injured patients, airway management, protecting breathing and circulation, major neurologic problems and the difficulties with clinical examination of whole-body could be managed through following the prepared guideline.

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Interventional Radiology service provision and practice for the management of traumatic splenic injury across the Regional Trauma Networks of England

Cited by 14 publications

References 8 publications

SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study

SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study

The Survival Benefit of a Novel Trauma Workflow that Includes Immediate Whole-body Computed Tomography, Surgery, and Interventional Radiology, All in One Trauma Resuscitation Room

A Review of Assessment and Treatment of Trauma in Emergency Department

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