title: Is non-operative management of severe blunt splenic injury safer than embolization or surgery? Results from a French prospective multicenter study.
abstract: OBJECTIVE
  The management of the severe blunt splenic injuries remains debated. The aim of this study is to evaluate the morbidity and mortality of splenic injury according to severity and management (surgery, embolization, non-operative management [NOM]).
  
  
  METHODS
  A prospective multicenter study was conducted including patients aged 16 years and older with diagnosed splenic injury. We evaluated severity according to the AAST classification, the presence of hemoperitoneum or a contrast blush on initial CT scan. The initial hemodynamic status, patients co-morbidities, the ISS (injury severity score), management and morbidity were also noted.
  
  
  RESULTS
  Between May 2010 and May 2012, 91 patients were included. Thirty-seven patients (41%) had mild splenic injury (AAST I or II and a small hemoperitoneum) while 54 patients (59%) had severe splenic injury (AAST III or greater). The management included 18 splenectomies (20%), 15 embolizations (16%). Among 67 patients undergoing NOM without initial embolization, five (7%) developed secondary bleeding, five required surgery and nine underwent secondary embolization. No patient died and morbidity was 44% (n=40), 13% for mild injuries vs. 65% for severe injuries (P<0.01). For severe injuries, total morbidity was 58% after NOM, 73% after embolization and 70% after surgery. Specific morbidity related to the management was 10% after NOM vs. 47% after embolization (P=0.02). Specific morbidity after surgery was 15%.
  
  
  CONCLUSIONS
  Embolization, because of its important specific morbidity, should not be performed as a prophylactic measure, but only in presence of clinical or laboratory signs of bleeding.
authors: Service de chirurgie digestive et cancérologie, centre hospitalier Carémeau, place du Pr-Robert Debré, 30000 Nîmes, France. Electronic address: ludovic.chastang@chu-nimes.fr.
authors: L
authors: L
authors: Chastang
authors: Service de chirurgie digestive, Hôpital nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
authors: T
authors: T
authors: Bège
authors: Service de chirurgie digestive et cancérologie, centre hospitalier Carémeau, place du Pr-Robert Debré, 30000 Nîmes, France.
authors: M
authors: M
authors: Prudhomme
authors: BESPIM, centre hospitalier Carémeau, place du Pr-Robert-Debré, 30000 Nîmes cedex 9, France.
authors: A C
authors: AC
authors: Simonnet
authors: Service de chirurgie digestive, centre hospitalier Saint-Éloi, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: A
authors: A
authors: Herrero
authors: Service de chirurgie digestive, centre hospitalier Saint-Éloi, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
authors: F
authors: F
authors: Guillon
authors: Service de chirurgie digestive, centre hospitalier Joffre, 20, avenue du Languedoc, 66000 Perpignan, France.
authors: D
authors: D
authors: Bono
authors: Service de chirurgie digestive, centre hospitalier Antoine-Gayraud, route de Saint-Hilaire, 11000 Carcassonne, France.
authors: E
authors: E
authors: Nini
authors: Service de chirurgie digestive, centre hospitalier, boulevard Docteur-Lacroix, 11100 Narbonne, France.
authors: T
authors: T
authors: Buisson
authors: Service de chirurgie digestive, centre hospitalier, avenue du 8-Mai-1945, 48000 Mende, France.
authors: G
authors: G
authors: Carbonnel
authors: Service de chirurgie digestive, centre hospitalier, 2, rue Valentin-Haûy, 34525 Béziers, France.
authors: L
authors: L
authors: Passebois
authors: Service de chirurgie digestive, centre hospitalier du Bassin de Thau, boulevard Camille Blanc, 34200 Sète, France.
authors: C
authors: C
authors: Vacher
authors: Service de chirurgie digestive et cancérologie, centre hospitalier Carémeau, place du Pr-Robert Debré, 30000 Nîmes, France.
authors: M-C
authors: MC
authors: Le Moine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013154:Spleen / Q000293:injuries / Q000601:surgery*; D013156:Splenectomy / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*
keywords: Blunt trauma; Morbidity; Spleen