title: A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes?
abstract: INTRODUCTION The spleen remains one of the most frequently injured organs following blunt abdominal trauma. In 2012, regional trauma networks were launched across England and Wales with the aim of improving outcomes following trauma. This retrospective cohort study investigated the management and outcomes of blunt splenic injuries before and after the establishment of regional trauma networks. METHODS A dataset was drawn from the Trauma Audit Research Network database of all splenic injuries admitted to English and Welsh hospitals from 1 April 2010 to 31 March 2014. Demographic data, injury severity, treatment modalities and outcomes were collected. Management and outcomes were compared before and after the launch of regional trauma networks. RESULTS There were 1457 blunt splenic injuries: 575 between 2010 and 2012 and 882 in 2012-14. Following the introduction of the regional trauma networks, use of splenic artery embolotherapy increased from 3.5% to 7.6% (P = 0.001) and splenectomy rates decreased from 20% to 14.85% (P = 0.012). Significantly more patients with polytrauma and blunt splenic injury were treated with splenic embolotherapy following 2012 (61.2% vs. 30%, P < 0.0001). Increasing age, injury severity score, polytrauma and Charlson Comorbidity Index above 10 were predictors of increased mortality (P < 0.001). Increasing systolic blood pressure (odds ratio, OR, 0.757, 95% confidence interval, CI, 0.716-0.8) and Glasgow Coma Scale (OR 0.988, 95% CI 0.982-0.995) were protective. CONCLUSIONS This study demonstrates a reduction in splenectomy rate and an increased use of splenic artery embolotherapy since the introduction of the regional trauma networks. This may have resulted from improved access to specialist services and reduced practice variation since the establishment of these networks.
authors: Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK.|North West Research Collaborative , Manchester , UK.
authors: P
authors: P
authors: Yiannoullou
authors: Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK.|North West Research Collaborative , Manchester , UK.
authors: C
authors: C
authors: Hall
authors: Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK.|North West Research Collaborative , Manchester , UK.
authors: K
authors: K
authors: Newton
authors: Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK.|North West Research Collaborative , Manchester , UK.
authors: L
authors: L
authors: Pearce
authors: Trauma Audit Research Network, Salford Royal NHS Foundation Trust, University of Manchester , Manchester , UK.
authors: O
authors: O
authors: Bouamra
authors: Trauma Audit Research Network, Salford Royal NHS Foundation Trust, University of Manchester , Manchester , UK.
authors: T
authors: T
authors: Jenks
authors: North West Research Collaborative , Manchester , UK.
authors: A B
authors: AB
authors: Scrimshire
authors: Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK.|North West Research Collaborative , Manchester , UK.
authors: J
authors: J
authors: Hughes
authors: Trauma Audit Research Network, Salford Royal NHS Foundation Trust, University of Manchester , Manchester , UK.|Emergency Medicine Research in Sheffield Group, Health Services Research Section, School of Health and Related Research, University of Sheffield , Manchester , UK.
authors: F
authors: F
authors: Lecky
authors: North West Research Collaborative , Manchester , UK.|Department of General Surgery, University Hospital South Manchester , Manchester , UK.
authors: Adh
authors: A
authors: Macdonald
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000401:mortality / Q000706:statistics & numerical data; D061665:Time-to-Treatment; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*
keywords: Abdominal injuries; Spleen; Trauma centres