title: Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.
abstract: OBJECTIVE
  The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol.
  
  
  METHODS
  All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation.
  
  
  RESULTS
  87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage.
  
  
  CONCLUSIONS
  The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.
authors.affiliation: Emergency Department, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. antonio_brillantino@libero.it.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-0198-8511
authors.initials: A
authors.lastname: Brillantino
authors.affiliation: Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Iacobellis
authors.affiliation: Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Robustelli
authors.affiliation: Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Villamaina
authors.affiliation: Department of Radiology, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Maglione
authors.affiliation: Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Colletti
authors.affiliation: Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: De Palma
authors.affiliation: Emergency Department, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Paladino
authors.affiliation: Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Noschese
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D002985:Clinical Protocols; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries*; D013157:Splenic Artery / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult
keywords: Angioembolization; Blunt trauma; Non operative management; Splenic injury; Splenic trauma