Splenic preservation after isolated splenic blunt trauma: The angioembolization paradox

Schneider, Andrew; Gallaher, Jared; Raff, Lauren; Purcell, Laura N.; Reid, Trista; Charles, Anthony

doi:10.1016/j.surg.2021.01.007

Cited by 15 publications

(15 citation statements)

References 17 publications

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“…In this study, the rate of patients with splenic injury with OM was higher than patients with NOM before 2010, which contrasted with many studies 5 7 9. However, patients undergoing NOM vastly outnumbered patients with OM after 2010.…”

Section: Discussioncontrasting

confidence: 65%

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Clinical features and direct medical cost of splenic injury in China: a cross-sectional study

Yong

Liu

et al. 2022

BMJ Open

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ObjectivesThis study analyses the clinical features and direct medical cost (DMC) of splenic injury during 2000–2013 in China.DesignThis was a cross-sectional study.MethodsWe used ‘The No. 1 Military Medical Project’ information system to conduct a retrospective study. Patients’ information from 2000 to 2013 were identified. Demographic data, treatment, clinical data and DMC were collected. We performed a generalised linear method (GLM) using gamma distribution to assess the drivers of DMCs.ResultsWe included 8083 patients with splenic injury who met the study criteria. Over the 14-year study period, 2782 (34.4%) patients were treated with non-operative management (NOM), 5301 (65.6%) with OM. From 2000 to 2013, the rate of NOM increased from 34.7% to 55.9%, while OM decreased from 65.3% to 44.1%. Mean per-patient DMC in both NOM and OM increased from 2000 to 2013. In GLM analysis, male, old age, length of stay, severe splenic injury grade, OM, intensive care unit, blood transfusion and tertiary hospitals were associated with higher DMC, while female and NOM was associated with lower DMC.ConclusionsIn China, management of splenic injury was the most important factor impacting the total DMC. Proper management and public policy could curtail the burden of splenic injury.

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Section: Discussioncontrasting

confidence: 65%

“…At present most of the studies on splenic injuries focused on the comparison of the safe and clinical outcomes of operative vs NOM 4 7. The direct medical cost (DMC) is a factor that cannot be neglected in evaluating if treatment strategies are proper from a healthcare economy point of view.…”

Section: Introductionmentioning

confidence: 99%

Clinical features and direct medical cost of splenic injury in China: a cross-sectional study

Yong

Liu

et al. 2022

BMJ Open

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“…A review of the National Trauma Data Bank, which is a central repository of clinical data pertaining to traumatic injuries submitted by trauma centers in the United States, evaluated the correlation between rates of SAE and splenectomy in the setting of isolated blunt splenic trauma from 2007 to 2015. 30 The authors found that, despite a 2-fold increase in rates of angioembolization during the study period, there was no change in overall splenectomy rates. Splenectomy rates in low-grade (I and II) splenic injury decreased with the increasing use of SAE, but this group may have also been managed successfully with observation alone.…”

Section: Historical Evolution Of Splenic Artery Angioembolizationmentioning

confidence: 93%

Update on Nonoperative Management of the Injured Spleen

Harfouche

Dhillon

Feliciano

2022

The American Surgeon

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Despite significant interest in trauma to the spleen over the past 130 years, splenectomy remained the preferred approach to splenic injures in children till the late 1950s and even later in adults. With recognition of the immunologic importance of the spleen and improvements in diagnostic imaging and angioembolization, there are now four pathways for the child or adult admitted with a possible, likely, or diagnosed injury to the spleen. These include the following: (1) operation with splenectomy; (2) operation with splenorrhaphy or partial splenectomy; (3) nonoperative management (observation); and (4) nonoperative management with splenic arteriography and possible angioembolization. This review will focus on the latter two options.

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“…10 Two studies using nationwide data between the late 2000s and early 2010s showed that overall splenectomy rates among high-grade BSI were stable despite an increased utilization of angiography. 11,12 Over the last decade, several studies highlighted the feasibility and efficacy of NOM with SAE for high-grade BSI. [13][14][15] In centers performing mandatory angiography for all patients with high-grade BSI undergoing NOM, failure rates of less than 10% have been reported, leading to an increasing number of centers performing SAE for patients with high-grade BSI.…”

mentioning

confidence: 99%

“…In fact, high-grade injury is considered one of the predictive factors for NOM failure 10 . Two studies using nationwide data between the late 2000s and early 2010s showed that overall splenectomy rates among high-grade BSI were stable despite an increased utilization of angiography 11,12 . Over the last decade, several studies highlighted the feasibility and efficacy of NOM with SAE for high-grade BSI 13–15 .…”

mentioning

confidence: 99%

Recent trends in the management of isolated high-grade splenic injuries: A nationwide analysis

Aoki

Onogawa

Matsumoto

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:The feasibility of nonoperative management for high-grade blunt splenic injuries (BSIs) has been suggested in recent studies. The purpose of this study was to assess nationwide trends in the management of isolated high-grade BSIs. We hypothesized that isolated high-grade BSIs are more frequently being managed nonoperatively. METHODS:The American College of Surgeons Trauma Quality Improvement Program database was queried to identify patients (16 years or older) with isolated high-grade BSIs (Abbreviated Injury Scale, ≥3) between 2013 and 2019. Patients were divided into two groups based on their hemodynamic status (hemodynamically stable [HS] and hemodynamically unstable [HU]). The primary outcome was the rate of total splenectomy each year, and the secondary outcome was the use of splenic angioembolization (SAE). Multiple regression models were created to estimate annual trends in splenectomy and SAE. RESULTS:A total of 6,747 patients with isolated high-grade BSIs were included: 5,714 (84.7%) and 1,033 (15.3%) in HS and HU groups, respectively. In the HS group, the rate of overall splenectomy was significantly decreased (from 22.9% in 2013 to 12.6% in 2019; odds ratio [OR] for 1-year increment, 0.850; 95% confidence interval [CI], 0.815-0.886; p < 0.001), and the use of SAE was significantly increased (from 12.5% in 2013 to 20.9% in 2019; OR, 1.107; 95% CI, 1.065-1.150; p < 0.001). In the HU group, the overall splenectomy rate was unchanged (from 69.8% in 2013 to 50.8% in 2019; OR, 0.931; 95% CI, 0.865-1.002; p = 0.071), whereas SAE was significantly increased (from 12.7% in 2013 to 28.8% in 2019; OR, 1.176; 95% CI, 1.079-1.284; p < 0.001). CONCLUSION:We observed significant trends toward more frequent use of nonoperative management in high-grade BSIs with hemodynamic stability. Further studies are warranted to define the role of SAE, especially in patients with hemodynamic instability.

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Splenic preservation after isolated splenic blunt trauma: The angioembolization paradox

Cited by 15 publications

References 17 publications

Clinical features and direct medical cost of splenic injury in China: a cross-sectional study

Clinical features and direct medical cost of splenic injury in China: a cross-sectional study

Update on Nonoperative Management of the Injured Spleen

Recent trends in the management of isolated high-grade splenic injuries: A nationwide analysis

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