title: Interventional Radiology service provision and practice for the management of traumatic splenic injury across the Regional Trauma Networks of England.
abstract: BACKGROUND
  The management of blunt splenic injuries (BSI) has evolved toward strategies that avoid splenectomy. There is growing adoption of interventional radiology (IR) techniques in non-operative management of BSI, with evidence suggesting a corresponding reduction in emergency laparotomy requirements and increased splenic preservation rates. Currently there are no UK national guidelines for the management of blunt splenic injury. This may lead to variations in management, despite the reorganisation of trauma services in England in 2012.
  
  
  METHODS
  A survey was distributed through the British Society of Interventional Radiologists to all UK members aiming to identify availability of IR services in England, radiologists' practice, and attitudes toward management of BSI.
  
  
  RESULTS
  116 responses from respondents working in 23 of the 26 Regional Trauma Networks in England were received. 79% provide a single dedicated IR service but over 50% cover more than one hospital within the network. All offer arterial embolisation for BSI. Only 25% follow guidelines. In haemodynamically stable patients, an increasing trend for embolisation was seen as grade of splenic injury increased from 1 to 4 (12.5%-82.14%, p<0.01). In unstable patients or those with radiological evidence of bleeding, significantly more respondents offer embolisation for grade 1-3 injuries (p<0.01), compared to stable patients. Significantly fewer respondents offer embolisation for grade 5 versus 4 injuries in unstable patients or with evidence of bleeding.
  
  
  CONCLUSIONS
  Splenic embolisation is offered for a variety of injury grades, providing the patient remains stable. Variation in interventional radiology services remain despite the introduction of regional trauma networks.
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: drjane_uk@yahoo.co.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: ashscrim@gmail.com.
authors.forename: Ashley
authors.initials: A
authors.lastname: Scrimshire
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: laurajsteinberg@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Steinberg
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: petros.yiann@me.com.
authors.forename: Petros
authors.initials: P
authors.lastname: Yiannoullou
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: katynewton2012@doctors.org.uk.
authors.forename: Katherine
authors.initials: K
authors.lastname: Newton
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: clairehall@doctors.org.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Hall
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: lpearce@doctors.org.uk.
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Pearce
authors.affiliation: Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1). Electronic address: adhmacdonald@gmail.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Macdonald
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods; D004739:England / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000706:statistics & numerical data; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015642:Radiology, Interventional; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D013156:Splenectomy / Q000706:statistics & numerical data; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Interventional radiology; Regional trauma networks; Spleen; Splenic embolisation; Splenic trauma