Management of Splenic Trauma: A New Ct‐guided Splenic Injury Grading System

Abstract

The aim of this study was to assess a newly developed computerized tomography (CT)‐based splenic injury index in predicting the outcome of splenic injury. Twelve patients with isolated splenic injuries were studied. Splenic parenchymal injury was graded from 1 to 4 based on CT. The splenic injury index was obtained by multiplying the parenchymal score by the volume of haemoperitoneum, which was measured on the CT scanner. The 12 patients with CT‐proven splenic injuries had a mean injury index of 193.5 ± 191 (mean ± s.d.). The 3 patients who failed conservative management had a mean index of 475 ± 50, compared with an index of 99.5 ± 100 in the nine managed non‐operatively (P < 0.001). This new CT‐based splenic injury index allows morphological assessment of splenic injury and may predict the outcome of splenic trauma.

Adult Splenic Injuries: Treatment Patterns and Predictive Indicators

“…Although not reaching statistical significance and if the problem with small numbers is accepted, the trend still seen in the CT findings of this study would suggest that a patient having a CT Buntain Grade IV injury to the spleen would be likely to fail conservative treatment and would probably be best managed by early surgical intervention regardless of the cardiovascular status of the patient. This would concur with the findings of Sugrue et al who also found that CT changes were predictive of the outcome of non-operative management 17 and of Chiu et al who found that only 9% of grade IV injuries had successful non-operative treatment. 19 Stanley-Smith et al also found that among other indicators a high-grade CT injury was predictive of failing non-operative management.…”

“…This compares with 22–67% in USA studies, 4 , 9 , 10 , 16 which were also based on similar criteria including confining it to patients with blunt injury mechanisms. More specific to the Australasian scene, where blunt trauma mechanisms make up a higher proportion, is the study from Sugrue et al where 75% were treated non‐operatively initially 17 …”

Failure of Nonoperative Management of Splenic Injuries

“…Computed tomographic scan grading of splenic injuries was initially thought to be a useful tool in stratifying high-and low-risk patients, but it has subsequently been shown to have only a modest ability to predict the likelihood of persistent or recurrent bleeding. 1,2 Moreover, there is evidence suggesting that intrarater and interrater reliability in grading splenic injuries is poor. 3 Further, the time to failure has been poorly defined, resulting in variability in the intensity and duration of in-hospital observation.…”

Isolated Blunt Splenic Trauma in Adults

“…Fur thermore, this technique is of high performance for the diagnosis of splenic lesions but may underestimate their seriousness [6][7][8]. Splenic injury scores, based on CT scan data, have been put forward to discriminate rapidly between patients requiring surgery, and those who may benefit from conservative treatment [7,10,11,14], The use of these scores in the clinical context is controversial [3,6,9,15,16]. Comparison of score results is difficult due to differences in the type of patients studied (children-adults), and in the importance of splenic injuries.…”

“…CT scan of the abdomen is a highly accurate meth od of diagnosing splenic injury, although the severity of the injury may be misjudged by the scan [6][7][8], CT scan ning should therefore help to orientate the handling of splenic trauma. Various scores have been established for the purpose of determining which splenic injuries can be managed nonoperatively, and which require surgery [7][8][9][10][11]. The usefulness of such scores is controversial…”