Subcapsular hematoma in blunt splenic injury

Abstract

Therapeutic study, level IV.

Blunt splenic injury, Emergency Department to discharge: A Western Trauma Association critical decisions algorithm

“…(E) Hemodynamically stable patients with high-grade injuries defined by the presence of a vascular injury should undergo angiography and embolization of abnormal structures. In addition, data do exist to suggest that higher-grade injuries (III–V) even without evidence of vascular injury may have improved nonoperative failure rates with preemptive or prophylactic splenic angioembolization (SAE) 4,5 . Failure of nonoperative management of Grades III to V blunt splenic injuries without embolization has been reported as high as 31%, compared with 5% in patients who underwent embolization whether a vascular injury was identified on CT 6,7 .…”

“…In addition, data do exist to suggest that higher-grade injuries (III-V) even without evidence of vascular injury may have improved nonoperative failure rates with preemptive or prophylactic splenic angioembolization (SAE). 4,5 Failure of nonoperative management of Grades III to V blunt splenic injuries without embolization has been reported as high as 31%, compared with 5% in patients who underwent embolization whether a vascular injury was identified on CT. 6,7 Conversely, one large, prospective multi-institutional European study randomized patients with high-risk BSI (Grades III-V) to prophylactic SAE versus surveillance with SAE as needed and showed an equivalent splenic rescue rate (98.2% vs. 93.3%, respectively; p = 0.37) at 1 month. 8…”

Size of Splenic Subcapsular Hematoma Is Associated With Varying Outcomes of Nonoperative Management

“…Older literature report varying rates for patients specifically with SCHs but are as high as 80% in those with high-grade injuries. 4 The aims of this study were to determine contemporary rates of FNOM in patients who have a SCH and to identify features that would be associated with failure. We hypothesized that contemporary rates of FNOM for SCH are lower than previously reported and that FNOM correlated with the size of SCH on initial imaging.…”

“…Older literature report varying rates for patients specifically with SCHs but are as high as 80% in those with high-grade injuries. 4…”

Management of blunt splenic injury: down the rabbit hole and into the bucket

“… 10 11 These inquiries led to multicenter studies sponsored 12 by the American Association for the Surgery of Trauma, Western Trauma Association and others to further refine our management strategies. 13–34 …”