title: [Multidisciplinary protocol for computed tomography imaging and angiographic embolization of splenic injury due to trauma: assessment of pre-protocol and post-protocol outcomes].
abstract: OBJECTIVE
  To assess conservative treatment of splenic injury due to trauma, following a protocol for computed tomography (CT) and angiographic embolization. To quantify the predictive value of CT for detecting bleeding and need for embolization.
  
  
  METHODS
  The care protocol developed by the multidisciplinary team consisted of angiography with embolization of lesions revealed by contrast extravasation under CT as well as embolization of grade III-V injuries observed, or grade I-II injuries causing hemodynamic instability and/or need for blood transfusion. We collected data on demographic variables, injury severity score (ISS), angiographic findings, and injuries revealed by CT. Pre-protocol and post-protocol outcomes were compared. The sensitivity and specificity of CT findings were calculated for all patients who required angiographic embolization.
  
  
  RESULTS
  Forty-four and 30 angiographies were performed in the pre- and post-protocol periods, respectively. The mean (SD) ISSs in the two periods were 25 (11) and 26 (12), respectively. A total of 24 (54%) embolizations were performed in the pre-protocol period and 28 (98%) after implementation of the protocol. Two and 7 embolizations involved the spleen in the 2 periods, respectively; abdominal laparotomies numbered 32 and 25, respectively, and 10 (31%) vs 4 (16%) splenectomies were performed. The specificity and sensitivity values for contrast extravasation found on CT and followed by embolization were 77.7% and 79.5%.
  
  
  CONCLUSIONS
  The implementation of this multidisciplinary protocol using CT imaging and angiographic embolization led to a decrease in the number of splenectomies. The protocol allows us to take a more conservative treatment approach.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Idibell, Barcelona. mkoo@bellvitgehospital.cat
authors.forename: M
authors.initials: M
authors.lastname: Koo
authors.forename: A
authors.initials: A
authors.lastname: Sabaté
authors.forename: P
authors.initials: P
authors.lastname: Magalló
authors.forename: M A
authors.initials: MA
authors.lastname: García
authors.forename: J
authors.initials: J
authors.lastname: Domínguez
authors.forename: M E
authors.initials: ME
authors.lastname: de Lama
authors.forename: S
authors.initials: S
authors.lastname: López
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D011237:Predictive Value of Tests; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy