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Blunt splenic injury: operation versus angiographic embolization
Wendy L Wahl1, Karla S Ahrns, Steven Chen
1Trauma Burn Center, University of Michigan Health System, Ann Arbor 48109-0033, USA.
Surgery
|October 7, 2004
Summary
Angiographic embolization (AE) for splenic injuries is safe and effective, showing fewer complications than operative management. This study supports AE as a viable non-operative treatment for blunt splenic trauma.
Area of Science:
- Trauma Surgery
- Interventional Radiology
- Emergency Medicine
Background:
- Non-operative management is increasingly used for blunt splenic injuries.
- Angiographic embolization (AE) is an emerging treatment option.
- This study compares AE to traditional operative management.
Purpose of the Study:
- To evaluate the outcomes of AE versus operative management for splenic injuries.
- To compare mortality, costs, complications, and duration of stay.
- To identify predictors for operative intervention.
Main Methods:
- Retrospective review of a prospective data set of adult splenic injuries (2000-2003).
- Comparison of patients undergoing AE versus operative management (CT+OR).
- Analysis of demographics, injury severity, hemodynamics, costs, and outcomes.
Main Results:
- AE group had fewer abdominal complications (13% vs 29%) but similar mortality (8% vs 4%) compared to CT+OR.
- Total costs were comparable after adjustment for injury severity and other factors.
- Non-operative failure rate was 2%; injury severity score and hemodynamic instability predicted need for operation.
Conclusions:
- Angiographic embolization (AE) for splenic injuries is safe and leads to fewer complications.
- AE is a viable alternative to operative management for blunt splenic trauma.
- Predictors for operative intervention include higher injury severity score and hemodynamic instability.