Selective angiographic embolization of blunt splenic traumatic injuries in adults decreases failure rate of nonoperative management.
BACKGROUND
To determine whether angioembolization (AE) in hemodynamically stable adult patients with blunt splenic trauma (BST) at high risk for failure of nonoperative management (NOM) (contrast blush [CB] on computed tomography, high-grade IV-V injuries, or decreasing hemoglobin) results in lower failure rates than reported.


METHODS
The records of patients with BST from July 2000 to December 2010 at a Level I trauma center were retrospectively reviewed using National Trauma Registry of the American College of Surgeons. Failure of NOM (FNOM) occurred if splenic surgery was required after attempted NOM. Logistic regression analysis was used to identify factors associated with FNOM.


RESULTS
A total of 1,039 patients with BST were found. Pediatric patients (age <17 years), those who died in the emergency department, and those requiring immediate surgery for hemodynamic instability were excluded. Of the 539 (64% of all BST) hemodynamically stable patients who underwent NOM, 104 (19%) underwent AE and 435 (81%) were observed without AE (NO-AE). FNOM for the various groups were as follows: overall NOM (4%), NO-AE (4%), and AE (4%). There was no significant difference in FNOM for NO-AE versus AE for grades I to III: grade I (1% vs. 0%, p = 1), grade II (2% vs. 0%, p = 0.318), and grade III (5% vs. 0%, p = 0.562); however, a significant decrease in FNOM was noted with the addition of AE for grades IV to V: grade IV (23% vs. 3%, p = 0.04) and grade V (63% vs. 9%, p = 0.03). Statistically significant independent risk factors for FNOM were grade IV to V injuries and CB.


CONCLUSIONS
Application of strictly defined selection criteria for NOM and AE in patients with BST resulted in one of the lowest overall FNOM rates (4%). Hemodynamically stable BST patients are candidates for NOM with selective AE for high-risk patients with grade IV to V injuries, CB on initial computed tomography, and/or decreasing hemoglobin levels.


METHODS
III, therapeutic study.
Division of Acute Care Surgery (I.S.B.), Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida 32209, USA. Indermeet.bhullar@jax.ufl.edu
Indermeet S
IS
Bhullar
Eric R
ER
Frykberg
Daniel
D
Siragusa
David
D
Chesire
Julia
J
Paul
Joseph J
JJ
Tepas
Andrew J
AJ
Kerwin
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000792:Angiography / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*