Predicting Angioembolization Failure in Blunt Splenic Trauma

BackgroundSplenic artery angioembolization (SAAE) for high-grade blunt splenic injuries is an accepted adjunct to nonoperative management. We aimed to determine SAAE failure rates and identify predictive factors for SAAE failure (F-EMBO).MethodsWe conducted a retrospective review of TQIP (2018-2022) for adult patients with AAST Grade III-V blunt splenic injuries who underwent SAAE within 24 hours of arrival. F-EMBO was defined as requiring subsequent splenectomy within 4 days or repeat SAAE ≥1 hour after initial procedure. Univariable analysis compared successful SAAE (S-EMBO) vs F-EMBO characteristics and outcomes. A gradient boosting machine model with SHapley Additive exPlanations (SHAP) identified F-EMBO predictive factors.ResultsAmong 6055 patients, 5694 (94.0%) had S-EMBO and 361 (6.0%) had F-EMBO. Of F-EMBO patients, 167 (2.8%) required splenectomy while 204 (3.4%) required repeat SAAE. F-EMBO patients had higher rates of anticoagulation therapy (11.6% vs 6.1%, P < 0.001) and cirrhosis (4.2% vs 2.2%, P < 0.05). They demonstrated higher pulse rates (97 vs 92 bpm, P < 0.01), lower systolic blood pressure (108 vs 122 mmHg, P < 0.001), and received higher red blood cell volumes within 4 hours (600cc vs 0cc, P < 0.001). F-EMBO patients had higher mortality (9.1% vs 3.2%, P < 0.001), more complications, longer stays, and higher nonhome discharge rates. The top predictive factors were RBC volume (SHAP = 1.12), systolic blood pressure (0.23), injury severity score (0.16), age (0.16), and pulse rate (0.10).DiscussionRBC transfusion requirements, SBP, ISS, age, and pulse rates are the top influential factors predicting F-EMBO in adult patients with AAST III-V spleen injuries due to blunt trauma.