Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization.
BACKGROUND
This retrospective review tests the hypothesis that including selective splenic arteriography and embolization in the algorithm of a previously existing nonoperative management (NOM) strategy will result in higher rates of successful NOM in patients with blunt splenic injury.


METHODS
All patients with blunt splenic injuries documented by computed tomographic scan and/or operative findings over a 24-month period at a Level I trauma center were reviewed. A previously published series from this institution of 251 patients with splenic injury (Group 1) was then compared with the patients that constitute this current review (Group 2). Group 2 was then compared with patients described in a previous publication advocating nonselective arteriography in blunt splenic injuries.


RESULTS
Thirteen patients with blunt splenic injury in Group 2 underwent 14 splenic embolization procedures, with 12 (93%) being successfully treated without operation. Group 2 had a significantly higher NOM rate (82% vs. 65%, p < 0.01) than Group 1. These results are similar to the series published by Sclafani et al. (82.1% vs. 83.1%) in which every patient with splenic injury that was managed non-operatively underwent arteriography with or without embolization.


CONCLUSIONS
A high rate of NOM can be achieved with observation and selective use of arteriography with or without embolization in the management of blunt splenic injuries.
Dent
Daniel
D
Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. dent@thscsa.edu
Alsabrook
Grady
G
Erickson
Brian A
BA
Myers
John
J
Wholey
Michael
M
Stewart
Ronald
R
Root
Harlan
H
Ferral
Hector
H
Postoak
Darren
D
Napier
Dacia
D
Pruitt
Basil A
BA
D000465:Algorithms; D000704:Analysis of Variance; D000792:Angiography / Q000379:methods* / Q000592:standards; D001794:Blood Pressure; D003131:Combined Modality Therapy; D003663:Decision Trees; D004621:Embolization, Therapeutic / Q000379:methods* / Q000592:standards; D006339:Heart Rate; D006400:Hematocrit; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D018579:Patient Selection; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy; D013781:Texas; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*