Faculty Collaboration Database

The splenic injury outcomes trial: An American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2015 Sep;79(3):335-42

Date

08/27/2015

Pubmed ID

26307863

DOI

10.1097/TA.0000000000000782

Scopus ID

2-s2.0-84940835440 (requires institutional sign-in at Scopus site)   80 Citations

Abstract

BACKGROUND: Delayed splenic hemorrhage after nonoperative management (NOM) of blunt splenic injury (BSI) is a feared complication, particularly in the outpatient setting. Significant resources, including angiography (ANGIO), are used in an effort to prevent delayed splenectomy (DS). No prospective, long-term data exist to determine the actual risk of splenectomy. The purposes of this trial were to ascertain the 180-day risk of splenectomy after 24 hours of NOM of BSI and to determine factors related to splenectomy.

METHODS: Eleven Level I trauma centers participated in this prospective observational study. Adult patients achieving 24 hours of NOM of their BSI were eligible. Patients were followed up for 180 days. Demographic, physiologic, radiographic, injury-related information, and spleen-related interventions were recorded. Bivariate and multivariable analyses were used to determine factors associated with DS.

RESULTS: A total of 383 patients were enrolled. Twelve patients (3.1%) underwent in-hospital splenectomy between 24 hours and 9 days after injury. Of 366 discharged with a spleen, 1 (0.27%) required readmission for DS on postinjury Day 12. No Grade I injuries experienced DS. The splenectomy rate after 24 hours of NOM was 1.5 per 1,000 patient-days. Only extravasation from the spleen at time of admission (ADMIT-BLUSH) was associated with splenectomy (odds ratio, 3.6; 95% confidence interval, 1.4-12.4). Of patients with ADMIT-BLUSH (n = 49), 17 (34.7%) did not have ANGIO with embolization (EMBO), and 2 of those (11.8%) underwent splenectomy; 32 (65.3%) underwent ANGIO with EMBO, and 2 of those (6.3%, p = 0.6020 compared with no ANGIO with EMBO) required splenectomy.

CONCLUSION: Splenectomy after 24 hours of NOM is rare. After the initial 24 hours, no additional interventions are warranted for patients with Grade I injuries. For Grades II to V, close observation as an inpatient or outpatient is indicated for 10 days to 14 days. ADMIT-BLUSH is a strong predictor of DS and should lead to close observation or earlier surgical intervention.

LEVEL OF EVIDENCE: Prognostic/epidemiological study, level III; therapeutic study, level IV.

Author List

Zarzaur BL, Kozar R, Myers JG, Claridge JA, Scalea TM, Neideen TA, Maung AA, Alarcon L, Corcos A, Kerwin A, Coimbra R

Author

Todd A. Neideen MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Angiography
Embolization, Therapeutic
Female
Humans
Male
Middle Aged
Prospective Studies
Risk Factors
Spleen
Splenectomy
Time Factors
Trauma Centers
Treatment Outcome
United States
Wounds, Nonpenetrating