Patient selection in non-operative blunt splenic injury management: A comparative evaluation of MDCT grading systems

Blunt splenic trauma requires accurate MDCT grading for nonoperative management (NOM) success, yet existing morphology-based systems often fail to account for vascular injuries and hemoperitoneum volume that predict treatment failure. Therefore, it is of interest to evaluate 200 MDCT-scanned patients, comparing grading scales with NOM outcomes, including surgery rates, transfusions, hospital stay, and complications, across injury severities. Higher injury grades, contrast extravasation, large hemoperitoneum, and vascular lesions strongly correlated with NOM failure and adverse events in multivariate analysis. Grading incorporating quantitative hemoperitoneum and vascular markers outperformed traditional morphology-only systems in predictive accuracy for clinical decision-making. Thus, we document integrated MDCT parameters as essential for optimizing NOM selection, thereby reducing unnecessary surgeries and improving risk stratification in splenic trauma care.