Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis

Area of Science:

• Trauma surgery
• Interventional radiology
• Surgical outcomes

Background:

• Non-operative management (NOM) is standard for hemodynamically stable blunt splenic injury.
• Splenic artery embolization (SAE) is suggested to improve NOM success rates.
• Previous studies often used historical controls, limiting direct comparison.

Purpose of the Study:

• To compare the success rate of SAE versus observation alone in contemporaneous patients with blunt splenic injury.
• To evaluate if SAE enhances splenic salvage and reduces re-intervention compared to NOM without SAE.

Main Methods:

• Adult patients with blunt splenic injury undergoing NOM at Level 1 Trauma Centers were analyzed.
• Propensity scores were calculated to control for confounding variables between SAE and observation groups.
• A weighted relative risk was computed across propensity score strata to assess treatment success.

Main Results:

• Treatment was successful in 180/206 patients (92% observation vs. 84% SAE).
• The weighted relative risk for success with SAE was 1.17 (95% CI 0.94-1.45), not statistically significant.
• No significant difference in complication rates (weighted RR 0.71) or blood transfusions was observed.

Conclusions:

• After adjusting for confounders using propensity score stratification, SAE did not offer a significant advantage over observation alone for blunt splenic injury.
• The findings suggest that observation alone may be as effective as SAE in achieving successful non-operative management of blunt splenic injury.