The treatment of spleen injuries: a retrospective study

Abstract

BackgroundHemorrhage after blunt trauma is a major contributor to death after trauma. In the abdomen, an injured spleen is the most frequent cause of major bleeding. Splenectomy is historically the treatment of choice. In 2007, non-operative management (NOM) with splenic artery embolization (SAE) was introduced in our institution. The indication for SAE is hemodynamically stable patients with extravasation of contrast, or grade 3–5 spleen injury according to the Abbreviated Organ Injury Scale 2005, Update 2008. We wanted to examine if the introduction of SAE increased the rate of salvaged spleens in our trauma center.MethodAll patients discharged with the diagnosis of splenic injury in the period 01.01.2000 – 31.12.2013 from the University Hospital of North Norway Tromsø were included in the study. Patients admitted for rehabilitation purposes or with an iatrogenic injury were excluded.ResultsA total of 109 patients were included in the study. In the period 2000-7, 20 of 52 patients were splenectomized. During 2007-13, there were 6 splenectomies and 24 SAE among 57 patients. The reduction in splenectomies is significant (p < 0.001). There is an increase in the rate of treated patients (splenectomy and SAE) from 38 to 53 % in the two time periods, but not significantly (p = 0.65).ConclusionThe rate of salvaged spleens has increased after the introduction of SAE in our center.Trial registrationThe study is registered at www.clinicaltrials.gov with the identification number NCT01965548.

Overall Splenectomy Rates Stable Despite Increasing Usage of Angiography in the Management of High-grade Blunt Splenic Injury

“…Utilizing the NTDB, we studied 53,689 patients who sustained high-grade BSI. Several retrospective studies indicate an association between ANGIO and decreased rates of failure of NOM 2,3,[5][6][7][8][9][10][11][12][13][14][15][27][28][29][30] . Further, several centers now advocate ANGIO for all Grade III to V or IV to V BSI [9][10][11][12][13][14][15] .…”

“…Some centers follow selective ANGIO strategies where patients with BSI and a vascular abnormality seen on admission computed tomography (CT) scan are referred for ANGIO [5][6][7][8] . Other centers, based on evidence that CT may not be accurate at detecting vascular abnormalities that require embolization, advocate for the use of ANGIO for all patients with grades III-V or IV-V BSI, depending on the center [9][10][11][12][13][14][15][16] . Utilizing non-selective ANGIO strategies, authors report improvements in the proportion of patients successfully managed with NOM after protocol implementation.…”

“…Additionally, selection bias may also confound the relationship between ANGIO and splenic salvage. Many studies of ANGIO in the setting of BSI only report success of non-operative management [5][6][7][8][9][10][11][12][13][14][15] . Over time, changes in the use of urgent, or early splenectomy at a center could account for improvement in non-operative success.…”

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

“…A few meta-analyses showed a significant improvement in NOM success following introduction of AG/AE protocols (OR 0.26, 95% CI 0.13–0.53, p < 0.002) [ 54 , 80 – 82 ]. The failure rate without AG/AE is significantly higher than with AG/AE in AAST-OIS grade IV–V injuries (43.7 vs. 17.3%, p = 0.035, and 83.1 vs. 25.0%, p = 0.016, respectively) [ 80 ].…”

Splenic trauma in the twenty-first century: changing trends in management

“…45 Angiography and embolisation were recommended as an adjunct to nonoperative management for all grade III to grade V injuries. 46,47 However, splenic artery embolisation is associated with various complications (Table 3). [48][49][50][51][52][53][54] One study has shown no significant difference between embolisation and observation alone with regard to successful treatment in patients with blunt splenic trauma.…”