Decreased Frequency of Splenectomy for High-Grade Splenic Injuries Following the Implementation of an Interventional...

Area of Science:

• Trauma Surgery
• Vascular Interventional Radiology
• Surgical Outcomes

Background:

• A vascular interventional radiology (VIR) protocol was implemented at a Level 2 trauma center to decrease time to vessel puncture to under 60 minutes.
• The average time to vessel puncture decreased from 102 minutes to 48.2 minutes post-protocol implementation.
• A notable increase in splenic embolizations was observed after the protocol's initiation.

Purpose of the Study:

• To determine if the VIR protocol correlated with a decrease in splenectomies for high-grade splenic injuries (AAST grade 3 or higher) in favor of splenic embolization.
• To assess if the VIR alert protocol improved splenic salvage rates (preserved splenic immune function).
• To evaluate the impact of the protocol on splenectomy rates across all splenic injury grades.

Main Methods:

• A retrospective analysis of the trauma registry database for splenic injuries between January 2021 and September 2024.
• Injuries were graded using the American Association for the Surgery of Trauma (AAST) Organ Injury Scale based on admission CT scans.
• Demographic and clinical data were collected, and patients were categorized by intervention: splenectomy, embolization, or no intervention. Data were analyzed using chi-square and Mann-Whitney U tests.

Main Results:

• No statistically significant differences in clinical or demographic characteristics were found between pre- and post-protocol groups.
• A statistically significant decrease in splenectomies and a corresponding increase in splenic embolizations were observed for high-grade splenic injuries (p<0.001).
• This trend of decreased splenectomies and increased embolizations was also significant across all splenic injury grades (p<0.001).

Conclusions:

• The implementation of an institutional VIR alert protocol for hemorrhage control in trauma patients led to increased utilization of angioembolization for high-grade splenic injuries.
• This shift in practice resulted in a decreased rate of splenectomies.
• The VIR alert protocol correlated with a change in practice patterns, promoting splenic salvage attempts for all splenic injury grades.