Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study

Kristen Spoor¹, John David Cull², Banan W Otaibi³, Joshua P Hazelton³, John Chipko⁴, Jessica Reynolds⁵, Sam Fugate⁶, Claire Pederson⁷, Linda B Zier⁷, Lewis E Jacobson⁸, Jamie M Williams⁸, Thomas S Easterday⁹, Saskya Byerly¹⁰, Caleb Mentzer¹¹, Edward Hawke¹², Daniel C Cullinane¹³, Julianne B Ontengco¹⁴, Nikolay Bugaev¹⁵, Madison LeClair¹⁵, Pascal Udekwu¹⁶, Cooper Josephs¹⁷, Matthew Noorbaksh¹⁸, James Babowice¹⁹, Catherine Garrison Velopulos²⁰, Shane Urban²¹, Anna Goldenberg²², Gaby Ghobrial²³, John M Pickering²⁴, Steven D Quarfordt²⁴, Alia F Aunchman²⁵, Aimee K LaRiccia²⁵, Chance Spalding²⁶, Richard D Catalano²⁷, Jordan E Basham²⁸, Philip M Edmundson²⁹, Jeffry Nahmias²⁹, Erika Tay²⁹, Scott H Norwood³⁰, Katelyn Meadows³⁰, Yee Wong³¹, Claire Hardman³²

Affiliations

¹ Prisma Health Upstate, Greenville, South Carolina, USA.
² Surgery, Prisma Health Upstate, Greenville, South Carolina, USA.
³ Pennsylvania State University, Hershey, Pennsylvania, USA.
⁴ Research Medical Center, Kansas City, Missouri, USA.
⁵ University of Kentucky, Lexington, Kentucky, USA.
⁶ University of Kentucky HealthCare, Lexington, Kentucky, USA.
⁷ Medical Center of the Rockies, Loveland, Colorado, USA.
⁸ Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA.
⁹ University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁰ Surgery, UTHSC COM, Memphis, Tennessee, USA.
¹¹ Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA.
¹² Spartanburg Regional Health System, Spartanburg, South Carolina, USA.
¹³ Maine Medical Center, Portland, Maine, USA.
¹⁴ Surgery, Maine Medical Center, Portland, Maine, USA.
¹⁵ Tufts Medical Center, Boston, Massachusetts, USA.
¹⁶ Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
¹⁷ WakeMed Health, Raleigh, North Carolina, USA.
¹⁸ Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
¹⁹ Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
²⁰ University of Colorado, Denver, Colorado, USA.
²¹ Department of Surgery, University of Colorado, Aurora, Colorado, USA.
²² Trauma, Acute Care Surgery, and Surgical Critical Care, Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA.
²³ Cooper University Hospital, Camden, New Jersey, USA.
²⁴ Erlanger Health System, Chattanooga, Tennessee, USA.
²⁵ University of Vermont Medical Center, Burlington, Vermont, USA.
²⁶ Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA.
²⁷ Loma Linda University Adventist Health Sciences Center, Loma Linda, California, USA.
²⁸ Loma Linda University, Loma Linda, California, USA.
²⁹ Texas Health Presbyterian Hospital, Dallas, Texas, USA.
³⁰ UT Health East Texas, Tyler, Texas, USA.
³¹ Premier Health Partners Inc, Dayton, Ohio, USA.
³² Wright State Physicians, Department of Surgery, Dayton, Ohio, USA.

PMID: 38464553
PMCID: PMC10921525
DOI: 10.1136/tsaco-2023-001159

Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study

Kristen Spoor et al. Trauma Surg Acute Care Open. 2024.

. 2024 Mar 7;9(1):e001159.

doi: 10.1136/tsaco-2023-001159. eCollection 2024.

Authors

Affiliations

¹ Prisma Health Upstate, Greenville, South Carolina, USA.
² Surgery, Prisma Health Upstate, Greenville, South Carolina, USA.
³ Pennsylvania State University, Hershey, Pennsylvania, USA.
⁴ Research Medical Center, Kansas City, Missouri, USA.
⁵ University of Kentucky, Lexington, Kentucky, USA.
⁶ University of Kentucky HealthCare, Lexington, Kentucky, USA.
⁷ Medical Center of the Rockies, Loveland, Colorado, USA.
⁸ Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA.
⁹ University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁰ Surgery, UTHSC COM, Memphis, Tennessee, USA.
¹¹ Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA.
¹² Spartanburg Regional Health System, Spartanburg, South Carolina, USA.
¹³ Maine Medical Center, Portland, Maine, USA.
¹⁴ Surgery, Maine Medical Center, Portland, Maine, USA.
¹⁵ Tufts Medical Center, Boston, Massachusetts, USA.
¹⁶ Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
¹⁷ WakeMed Health, Raleigh, North Carolina, USA.
¹⁸ Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
¹⁹ Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
²⁰ University of Colorado, Denver, Colorado, USA.
²¹ Department of Surgery, University of Colorado, Aurora, Colorado, USA.
²² Trauma, Acute Care Surgery, and Surgical Critical Care, Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA.
²³ Cooper University Hospital, Camden, New Jersey, USA.
²⁴ Erlanger Health System, Chattanooga, Tennessee, USA.
²⁵ University of Vermont Medical Center, Burlington, Vermont, USA.
²⁶ Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA.
²⁷ Loma Linda University Adventist Health Sciences Center, Loma Linda, California, USA.
²⁸ Loma Linda University, Loma Linda, California, USA.
²⁹ Texas Health Presbyterian Hospital, Dallas, Texas, USA.
³⁰ UT Health East Texas, Tyler, Texas, USA.
³¹ Premier Health Partners Inc, Dayton, Ohio, USA.
³² Wright State Physicians, Department of Surgery, Dayton, Ohio, USA.

PMID: 38464553
PMCID: PMC10921525
DOI: 10.1136/tsaco-2023-001159

Abstract

Objectives: There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients.

Methods: A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined the failure rate of NOM for grade I versus grade II splenic injuries. We then performed bivariate comparisons of patients who failed NOM with those who did not.

Results: A total of 145 patients were included. Median Injury Severity Score was 17. The combined rate of failure for grade I-II injuries was 20.0%. There was no statistical difference in failure of NOM between grade I and II injuries with CB (18.2% vs 21.1%, p>0.05). Patients who failed NOM had an increased median hospital length of stay (p=0.024) and increased need for blood transfusion (p=0.004) and massive transfusion (p=0.030). Five patients (3.4%) died and 96 (66.2%) were discharged home, with no differences between those who failed and those who did not fail NOM (both p>0.05).

Conclusion: NOM of grade I-II splenic injuries with CB fails in 20% of patients.

Level of evidence: IV.

Keywords: abdominal injuries; spleen; treatment outcome.

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Conflict of interest statement

Competing interests: None declared.

Figures

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References

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Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study

Affiliations

Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials