Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma: early screening leads to a...

Area of Science:

• Trauma Surgery
• Radiology
• Vascular Interventions

Background:

• Delayed splenic rupture is a significant challenge in nonoperative management (NOM) of blunt splenic injury (BSI).
• Early identification of high-risk features like splenic pseudoaneurysms (SPAs) and arterial extravasation (AE) is crucial.
• Splenic arterial embolization (SAE) is a key intervention for managing high-risk injuries.

Purpose of the Study:

• To evaluate the effectiveness of a protocol involving mandatory 48-hour CT scans and selective SAE.
• To reduce the failure rate of nonoperative management in blunt splenic injuries.
• To analyze a 12-year experience with this management strategy.

Main Methods:

• Retrospective cohort analysis of adult trauma patients with BSI (1995-2012).
• Comparison of an early cohort (1995-1999) with a present cohort (2000-2012) implementing 48-hour CT and SAE.
• Inclusion of 773 patients (157 early vs. 616 present).

Main Results:

• Nonoperative management increased from 53% to 77% (p < 0.01).
• Splenic salvage rate improved from 46% to 77% (p < 0.01).
• Failure rate of NOM significantly decreased from 12% to 0.6% (p < 0.01) in the present cohort, with a reduced hospital stay.

Conclusions:

• Delayed development of SPAs and AE occurs in 6% of BSI cases.
• Mandatory 48-hour CT reevaluation and selective SAE are effective in decreasing NOM failure rates.
• This protocol enhances splenic salvage and reduces complications in blunt splenic injury.