Trauma centers with higher rates of angiography have a lesser incidence of splenectomy in the management of blunt splenic injury.
BACKGROUND
Nonoperative management (NOM) for blunt splenic injury (BSI) is well-established. Angiography (ANGIO) has been shown to improve success rates with NOM. Protocols for NOM are not standardized and vary widely between centers. We hypothesized that trauma centers that performed ANGIO at a greater rate would demonstrate decreased rates of splenectomy compared with trauma centers that used ANGIO less frequently.


METHODS
A large, multicenter, statewide database (Pennsylvania Trauma Systems Foundation) from 2007 to 2011 was used to generate the study cohort of patients with BSI (age ≥ 13). The cohort was divided into 2 populations based on admission to centers with high (≥13%) or low (<13%) rates of ANGIO. Patient demographics, grade of BSI, Injury Severity Score, level of trauma center designation, and patient volume were analyzed. Splenectomy rates were then compared between the 2 groups, and multivariable logistic regression for predictors of splenectomy (failed NOM) were also performed.


RESULTS
The overall rate of splenectomy in the entire cohort was 21.0% (1,120 of 5,333 BSI patients). The high ANGIO group had a lesser rate of splenectoy compared with the low ANGIO group (19% vs 24%; P < .001). Treatment at high ANGIO centers was negatively associated with splenectomy compared with low ANGIO centers (odds ratio, 0.68; 95% CI 0.58-0.80; P < .001); this association was independent of the number of BSI admissions or level of trauma center designation.


CONCLUSIONS
Treatment of BSI at trauma centers that performed ANGIO more frequently resulted in lesser splenectomy rates compared with centers with lesser rate of ANGIO. Inclusion of angiographic protocols for NOM of BSI should be considered strongly.
Allegheny General Hospital, Pittsburgh, PA. Electronic address: lcapecci@wpahs.org.
Louis M
LM
Capecci
Lowell General Hospital, Lowell, MA.
Elan
E
Jeremitsky
University of Florida, Gainesville, FL.
R Stephen
RS
Smith
Allegheny General Hospital, Pittsburgh, PA.
Frances
F
Philp
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D055815:Young Adult