title: Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury.
abstract: BACKGROUND
  Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center.
  
  
  METHODS
  An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment.
  
  
  RESULTS
  A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%.
  
  
  CONCLUSIONS
  SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United States.
authors: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 Amsterdam, The Netherlands. c.h.vandervlies@amc.uva.nl
authors: C H
authors: CH
authors: van der Vlies
authors: J
authors: J
authors: Hoekstra
authors: K J
authors: KJ
authors: Ponsen
authors: J A
authors: JA
authors: Reekers
authors: O M
authors: OM
authors: van Delden
authors: J C
authors: JC
authors: Goslings
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D013157:Splenic Artery; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*