Outcomes Following Blunt Traumatic Splenic Injury Treated with Conservative or Operative Management

Corn, Sarah; Reyes, Jared; Helmer, Stephen D.; Haan, James M.

doi:10.17161/kjm.v12i3.11798

Cited by 16 publications

(11 citation statements)

References 35 publications

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“…Complications from SAE have been reported with a wide range of incidence (Table 2). Major complications range from 0 to 29% and minor complications range from 5% to 62% (58,66,67,79,80). A multi-institutional retrospective review of 140 patients showed an overall complication rate of 36% with a 20% major complication rate and 23% minor complication rate (67).…”

Section: Complications From Saementioning

confidence: 99%

“…A multi-institutional retrospective review of 140 patients showed an overall complication rate of 36% with a 20% major complication rate and 23% minor complication rate (67). No significant difference in overall complication rate has been demonstrated between proximal and distal embolization (66,67,79,85). Recurrent intra-abdominal bleeding was the most common major complication and occurred in 11% of patients requiring either repeat embolization or splenectomy (67).…”

Section: Complications From Saementioning

confidence: 99%

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Splenic trauma: endovascular treatment approach

Cretcher¹,

Panick²,

Boscanin³

et al. 2021

Ann Transl Med

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The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used.Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.

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Section: Complications From Saementioning

confidence: 99%

Section: Complications From Saementioning

confidence: 99%

Splenic trauma: endovascular treatment approach

Cretcher¹,

Panick²,

Boscanin³

et al. 2021

Ann Transl Med

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“…Overall, most patients were male (n = 58), were a median age of 26 (21-42) years old, most (n = 62) had no comorbidities, and 47 had been injured from a ski/snowboarding accident. Compared to admitted patients, significantly more females were transferred, (13/38 vs. 3/36, p = 0.007, Table 1), more had an abbreviated injury scale score (AIS) ≥ 3 (vs < 3) of the chest (31/38 vs. 7/35, p = 0.002) and had a higher injury severity score (16 (16-22) vs. 13 (9)(10)(11)(12)(13)(14)(15)(16), p = 0.008), in comparison to admitted patients.…”

Section: Resultsmentioning

confidence: 99%

“…Thus, lower-level trauma centers with limited resources must expeditiously decide who can be immediately transferred to a higher level of care for SAE and who can be safely admitted for either surgery (exploratory laparotomy and splenectomy) or observation. Although there are a proliferation of studies examining the triage of splenic injuries [3,[6][7][8][9][10][11][12][13][14][15], there are a paucity of studies on management of patients with blunt splenic injuries in remote settings and of the few that exist, most report very small numbers and are not current [16,17]. There continues to be great variability in the processes of care for splenic injury patients, with sparse data reported across Level III or IV trauma centers.…”

Section: Introductionmentioning

confidence: 99%

Predictors of transfer from a remote trauma facility to an urban level I trauma center for blunt splenic injuries: a retrospective observational multicenter study

McGraw

Mains²,

Taylor

et al. 2022

Patient Saf Surg

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Background The decision-making for admission versus emergent transfer of patients with blunt splenic injuries presenting to remote trauma centers with limited resources remains a challenge. Although splenectomy is standard for hemodynamically unstable patients, the specific criterion for non-operative management continues to be debated. Often, lower-level trauma centers do not have interventional radiology capabilities for splenic artery embolization, leading to transfer to a higher level of a care. Thus, the aim of this study was to identify specific characteristics of patients with blunt splenic injuries used for admittance or transfer at a remote trauma center. Methods A retrospective observational study was performed to examine the management of splenic injuries at a mountainous and remote Level III trauma center. Trauma patients ≥ 18 years who had a blunt splenic injury and initially received care at a Level III trauma center prior to admittance or transfer were included. Data were collected over 4.5 years (January 1, 2016 – June 1, 2020). Patients who were transferred out in > 24 h were excluded. Patient demographics, injury severity, spleen radiology findings, and clinical characteristics were compared by decision to admit or transfer to a higher level of care ≤ 24 h of injury. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Multivariable logistic models were used to identify predictors of transfer. Results Of the 73 patients included with a blunt splenic injury, 48% were admitted and 52% were transferred to a Level I facility. Most patients were male (n = 58), were a median age of 26 (21–42) years old, most (n = 62) had no comorbidities, and 47 had been injured from a ski/snowboarding accident. Compared to admitted patients, transferred patients were significantly more likely to be female (13/38 vs. 3/36, p = 0.007), to have an abbreviated injury scale score ≥ 3 of the chest (31/38 vs. 7/35, p = 0.002), have a higher injury severity score (16 (16–22) vs. 13 (9–16), p = 0.008), and a splenic injury grade ≥ 3 (32/38 vs. 12/35, p < 0.001). After adjustment, splenic injury grade ≥ 3 was the only predictor of transfer (OR: 12.1, 95% CI: 3.9–37.3, p < 0.001). Of the 32 transfers with grades 3–5, 16 were observed, and 16 had an intervention. Compared to patients who were observed after transfer, significantly more who received an intervention had a blush on CT (1/16 vs. 7/16, p = 0.02) and a higher median spleen grade of 4 (3–5) vs. 3 (3–3.5), p = 0.01). Conclusions Our data suggest that most patients transferred from a remote facility had a splenic injury grade ≥ 3, with concomitant injuries but were hemodynamically stable and were successfully managed non-operatively. Stratifying by spleen grade may assist remote trauma centers with refining transfer criteria for solid organ injuries.

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“…Of note, the patients in the operative and embolization groups had similar splenic injury grades, but patients in the operative group had more severe hemoperitoneum. 15…”

Section: Complicationsmentioning

confidence: 99%

Update: Splenic Artery Embolization in Blunt Abdominal Trauma

Patil

Goodin

Findeiss

2020

Semin intervent Radiol

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The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management with splenic arterial embolization (SAE) is the current standard of care for hemodynamically stable patients. Current data favor the use of proximal and coil embolization techniques in adults, while observation is suggested in the pediatric population. In this review, the authors describe the most recent evidence informing the clinical indications, techniques, and complications for SAE.

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Outcomes Following Blunt Traumatic Splenic Injury Treated with Conservative or Operative Management

Cited by 16 publications

References 35 publications

Splenic trauma: endovascular treatment approach

Splenic trauma: endovascular treatment approach

Predictors of transfer from a remote trauma facility to an urban level I trauma center for blunt splenic injuries: a retrospective observational multicenter study

Update: Splenic Artery Embolization in Blunt Abdominal Trauma

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