Management of penetrating splenic trauma; is it different to the management of blunt trauma?

Abstract

Purpose: We compare the treatment and outcomes of penetrating and blunt splenic trauma at Major Trauma Centres (MTC) within the UK.

Methods: Data obtained from the national Trauma Audit Research Network database identified all eligible splenic injuries admitted to MTC within England between 01/01/17-31/12/21. Demographics, mechanism of injury, splenic injury classification, associated injuries, treatment, and outcomes were compared.

Results: Penetrating injuries accounted for 5.9 % (235/3958) of splenic injuries, compared to blunt at 94.1 % (3723/3958). Most penetrating injuries (91.5 %, 215/235) resulted from stabbing. There was a statistically significant difference in first treatment between penetrating and blunt splenic injuries (p < 0.001), but similar trends between GSW and stab injuries. Most penetrating injuries were managed conservatively (68.9 %,162/235), with 10.6 % (25/235) embolized compared to 13.2 % (491/3723) for blunt splenic injury. More penetrating injuries (20.4 %, 48/235) underwent splenectomy compared to blunt injuries (8.8 %, 326/3723). Those receiving embolization after penetrating trauma had an 8.0 % (2/25) 30-day mortality compared with blunt at 8.6 % (42/491) and compared with 2.1 % (1/48) and 12.3 % (40/326) of those who received splenectomy in the penetrating and blunt groups, respectively. 8 out of the 25 penetrating trauma patients who underwent embolisation (32.0 %) required splenectomy due to embolisation failure compared to 5.3 % (26/491) in the blunt trauma group.

Conclusion: A trend is seen towards the use of operative management in penetrating splenic trauma. There is a high splenic embolisation failure rate (32.0 %) in penetrating trauma although mortality for those embolised was similar to the blunt injury group.

Keywords: Embolisation; Splenic injury; Trauma.