Severe Splenic Injuries in Patients With Multiple Trauma

Area of Science:

• Trauma Surgery
• Surgical Outcomes
• Emergency Medicine

Background:

• Optimal management for severe blunt splenic injuries (BSI) in polytrauma patients remains debated.
• This study evaluates early outcomes of three primary treatment strategies for severe BSI.

Purpose of the Study:

• To analyze treatment patterns and clinical outcomes for severe BSI in patients with multiple trauma.
• To compare open splenectomy (OS), splenic angioembolization (SAE), and observation (OBS) for severe BSI.

Main Methods:

• A cohort study using the American College of Surgeons Trauma Quality Improvement Program database (2017-2022).
• Adult patients with severe BSI and multiple trauma were analyzed, excluding those with minor injuries.
• Outcomes compared included mortality, complications (ARDS, cardiac arrest, sepsis), and length of stay (LOS), with subgroup analyses for hypotension and failed nonoperative management (NOM).

Main Results:

• Of 12,930 patients, 26.2% had OS, 19.6% SAE, and 54.2% OBS.
• SAE and OBS were associated with significantly lower mortality (HR 0.62 and 0.61, respectively) and fewer complications compared to OS.
• SAE and OBS groups had shorter hospital and ICU LOS; NOM failure increased complications compared to upfront OS.

Conclusions:

• Splenic salvage (SAE and OBS) in severe BSI patients with multiple trauma is associated with decreased mortality, fewer complications, and shorter hospital stays compared to splenectomy.
• Nonoperative management (NOM) is a viable option, even for hypotensive patients, with no increased mortality or complications.
• NOM should be considered for severe BSI in polytrauma patients, including those presenting with hypotension.