title: Blunt splenic injury: use of a multidetector CT-based splenic injury grading system and clinical parameters for triage of patients at admission.
abstract: OBJECTIVE
  To assess the use of a dual-phase multidetector computed tomography (CT)-based grading system alone and in combination with assessment of clinical parameters at triage of patients with blunt splenic injury for determination of appropriate treatment (observation, splenic artery embolization [SAE], or splenic surgery).
  
  
  METHODS
  This HIPAA-compliant retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Between January 2009 and July 2011, 171 hemodynamically stable patients with blunt splenic injury underwent multidetector CT at admission to the hospital. Images were reviewed by applying a multidetector CT-based grading system, and the amount of hemoperitoneum was quantified. Demographic data, vital signs, laboratory values, injury severity score, abbreviated injury severity, final treatment decision, and success of nonsurgical treatment were reviewed. Receiver operating characteristic curves and stepwise logistic regression analyses were performed to determine the optimal parameters for effective triage of patients.
  
  
  RESULTS
  One hundred seventy one patients with splenic injury underwent multidetector CT. At triage, clinical treatment decisions were made, and patients received either observation (85 of 171 [50%]) or splenic intervention (surgery, 19 of 171 [11%] or splenic angiography, 67 of 171 [39%]). Four patients underwent SAE after unsuccessful observation. Six of 171 (3.5%) other patients received unsuccessful nonsurgical treatment with SAE. No patients who received observation required splenectomy. Areas under the receiver operating characteristic curve (AUCs) showed that the CT grading system was the best individual predictor of successful observation (AUC, 0.95), and stepwise logistic regression analysis results showed that multidetector CT grade and the abbreviated injury scale score (AUC, 0.97; P = .02) were the best combination of variables for selection of patients for observation versus splenic intervention. The combination of abbreviated injury scale score, systolic blood pressure reading, and serum glucose level was the best triage model for decision making between splenectomy and SAE (AUC, 0.84).
  
  
  CONCLUSIONS
  The best individual predictor of successful observation in patients with blunt splenic injury was the CT-based grading system. Multidetector CT grade and abbreviated injury scale score were the best combination of variables for selection of patients for observation versus splenic intervention.
authors.affiliation: From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (N.S.); Department of Diagnostic Radiology and Nuclear Medicine (K.S., H.R., S.E.M.), Department of Epidemiology and Public Health (H.H.C.), and R. Adams Cowley Shock Trauma Center (J.M., T.M.S.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Cardiothoracic and Vascular Surgery, University of Texas-Houston, Houston, Tex (J.J.D.); and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, England (M.A.K.).
authors.forename: Nitima
authors.initials: N
authors.lastname: Saksobhavivat
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.forename: Hegang H
authors.initials: HH
authors.lastname: Chen
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.forename: Howard
authors.initials: H
authors.lastname: Richard
authors.forename: Mansoor Ali
authors.initials: MA
authors.lastname: Khan
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Mirvis
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries*; D014218:Triage / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy*; D055815:Young Adult