Angioembolization reduces operative intervention for blunt splenic injury.
BACKGROUND
Nonoperative management for blunt splenic injury (BSI) has become gold standard, but the role of angiographic embolization (AE) is still controversial for bleeding. We postulated that splenic AE for BSI would have superior outcomes compared with operation and increase our splenic salvage rate.


METHODS
This was a retrospective study of all adult trauma patients admitted to our Level I center from 2000 through 2006. Multivariate analysis adjusting for age, Injury Severity Score, and Glasgow Coma Scale score was performed. Only patients who had a computed tomographic (CT) scan before surgery (CT + OR) were compared with those who had CT scans then AE.


RESULTS
Eighty-seven of 317 patients required initial intervention for their BSI, for a no intervention rate (no OR or AE) of 73% and a nonoperative rate of 89%. The groups had similar Injury Severity Score, mortality, and lengths of stay. The AE group was older (p < 0.01), had higher spleen Abbreviated Injury Score (p = 0.02), and required significantly fewer packed RBC transfusions, p < 0.01. The overall hospitalization costs were not different, but the number of intraabdominal complications was higher for the CT + OR group (36% vs. 6%, p < 0.01). Pneumonia, thromboembolic events, and pleural effusions were equivalent. There were no deaths from splenic hemorrhage.


CONCLUSIONS
Despite recent concerns that AE may be overutilized for BSI, this study showed a lower incidence of abdominal complications and blood utilization in the AE group despite an older age and higher splenic Abbreviated Injury Score. Use of AE decreased operative intervention by 16%.
Wei
Benjamin
B
Department of Surgery, Henry Ford Health System Detroit, Michigan, USA.
Hemmila
Mark R
MR
Arbabi
Saman
S
Taheri
Paul A
PA
Wahl
Wendy L
WL
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000792:Angiography / Q000379:methods*; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D013156:Splenectomy / Q000379:methods / Q000706:statistics & numerical data*; D013161:Splenic Rupture / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*