Blunt trauma induced splenic blushes are not created equal

Area of Science:

• Trauma Surgery
• Radiology
• Emergency Medicine

Background:

• Contrast extravasation on computed tomography (CT) scans is typically an indicator for intervention in splenic injuries.
• However, patients transferred for angioembolization often show resolved contrast blush on repeat imaging.
• This suggests that not all splenic blushes necessitate immediate intervention.

Purpose of the Study:

• To evaluate whether contrast extravasation on initial CT imaging in patients with blunt splenic trauma is an absolute indication for intervention.
• To determine if a conservative management approach with observation and repeat imaging is a viable alternative.

Main Methods:

• A 10-year retrospective review of patients transferred with blunt splenic injuries and initial CT contrast extravasation.
• Analysis of patient demographics, injury severity, and management strategies (intervention vs. observation).

Main Results:

• 16 patients with splenic contrast blush were identified; 50% were managed non-operatively.
• Patients managed without intervention showed significantly lower admission heart rates and hematocrit decline.
• Repeat imaging revealed blush resolution in 3 of 8 observed patients, while 4 in the intervention group had ongoing extravasation.

Conclusions:

• Contrast extravasation on initial CT scans for blunt splenic trauma is not an absolute indication for intervention.
• Implementing a period of observation with repeat CT imaging can help avoid unnecessary, invasive procedures and associated complications.