Interventional Radiology service provision and practice for the management of traumatic splenic injury across the Regional Trauma Networks of England

Abstract

Introduction: 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.

Materials and 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.

Conclusion: 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.

Keywords: Interventional radiology; Regional trauma networks; Spleen; Splenic embolisation; Splenic trauma.