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Randomized Controlled Trial
. 2024 Dec;31(6):823-833.
doi: 10.1007/s10140-024-02285-3. Epub 2024 Oct 4.

Patient factors associated with embolization or splenectomy within 30 days of initiating surveillance for splenic trauma

Fatah Tidadini  1 , Eugenie Martinet  2 , Jean-Louis Quesada  2 , Alison Foote  2 , Chayma El Wafir  2 , Edouard Girard  3 , Catherine Arvieux  4 ; SPLASH study group
Collaborators, Affiliations
Randomized Controlled Trial

Patient factors associated with embolization or splenectomy within 30 days of initiating surveillance for splenic trauma

Fatah Tidadini et al. Emerg Radiol. 2024 Dec.

Abstract

Background: Non-operative management of hemodynamically stable patients with splenic trauma has been recommended for more than 25 years, but in practice embolization and/or splenectomy (intervention) is often needed within the first 30 days. Identifying the risk factors associated with the need for intervention could support more individualized decision-making.

Methods: We used data from the SPLASH randomized clinical trial, a comparison of outcomes of surveillance or embolization. 140 patients were randomized, 133 retained in the study (embolization n = 66; surveillance n = 67) and 103 screened and registered in the non-inclusion register. Multivariate Cox proportional hazards models with time-varying covariates were used to identify risk factors contributing to embolization and/or splenectomy within 30 days after initiating surveillance only for splenic trauma.

Results: 123 patients (median age, 30 [23; 48] years; 91 (74%) male) initially received non-operative management. At the day-30 visit, 34 (27.6%) patients had undergone an intervention (31 (25.2%) delayed embolization and 4 (3.3%) splenectomy). Multivariate analysis identified patients with OIS grade 4 or 5 splenic trauma (HR = 4.51 [2.06-9.88]) and (HR = 34.5 [6.84-174]); respectively) and splenic complications: arterial leak (HR = 1.80 [1.45-2.24]), pseudoaneurysm (HR = 1.22 [1.06-1.40]) and pseudocyst (HR = 1.41 [1.21-1.64]) to be independently associated with increased risk of need for an intervention within 30 days of initiating surveillance.

Conclusions: Our study shows that more than 1 in 4 patients who received non-operative management needed embolization or splenectomy by day 30. Arterial leak, pseudoaneurysm, pseudocyst, and OIS grade 4 or 5 were independent risk factors linked to the need for an intervention.

Trial registration: clinicaltrials.gov Identifier NCT02021396.

Keywords: Embolization; Risk factors; Splenectomy; Splenic trauma; Surveillance.

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Conflict of interest statement

Declarations. Conflict of Interest: The authors declare that they have no conflict of interest.

References

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