title: Management of splenic trauma: a single institution's 8-year experience.
abstract: BACKGROUND
  Management of splenic trauma has evolved, with current practice favoring selective angiographic embolization and non-operative treatment over immediate splenectomy. Defining the optimal selection criteria for the appropriate management strategy remains an important question.
  
  
  METHODS
  This retrospective registry review was conducted at a Level I trauma center. The patient population consisted of 20,561 patients in the State Trauma Registry from April 2004 to May 2012. Splenectomy, angiography, splenic embolization, nonoperative, and noninterventional (NI) observation were the management strategies under study. Morbidity and mortality were the outcome measures. Morbidity and mortality by management strategy.
  
  
  RESULTS
  During the 8-year study period, 926 (4.5%) patients sustained splenic injury. Observational management increased over time despite the similar distribution of splenic injury grade over the study period: grade I/II (50%), grade III (24.2%), and grade IV/V (25.8%). Mortality rates associated with each management strategy were the following: immediate splenectomy (IS; 25%), splenic embolization (SE; 3.9%), and angiography only or observation, that is, NI (6.5%) management. Injury severity score (ISS) was highest in IS (36.1 ± 1.3) compared with SE (29.1 ± 1.0, P = .001) and NI (21.6, P < .001). Splenectomy was required in 5 of the 129 (3.9%) patients managed with SE and 9 of the 677 (1.3%) patients managed by NI. Mortality was significantly lower among those managed by SE (odds ratio .12, 95% confidence interval: .05 to .32) or NI (odds ratio .21, 95% confidence interval: .12 to .35). This survival benefit was explained by the association of IS with systolic blood pressure <90, high ISS, low GCS at presentation, ISS, development of shock, need for transfusion, and multiorgan failure.
  
  
  CONCLUSIONS
  In this large 8-year single institution study, we observed an increase in nonoperative management by an increased application of angiography and embolization. An aggressive utilization of SE in patients with appropriate indications will result in low failure rates and improved mortality.
authors.affiliation: Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, Albany, NY 12208, USA. Electronic address: rosatic@mail.amc.edu.
authors.forename: Carl
authors.initials: C
authors.lastname: Rosati
authors.affiliation: Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Ashar
authors.initials: A
authors.lastname: Ata
authors.affiliation: Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Siskin
authors.affiliation: Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Domenic
authors.initials: D
authors.lastname: Megna
authors.affiliation: Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bonville
authors.affiliation: Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Stain
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000792:Angiography; D015897:Comorbidity; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy; D014193:Trauma Centers
keywords: Angiographic embolization; Laparotomy; Splenectomy