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Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study

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Abstract

Purpose

To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma.

Materials and methods

This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student’s t, chi-squared, and Cohen’s kappa tests.

Results

Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (k = 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (p < 0.05) predictors of OM. Nonoperative management (NOM) failed in 23 patients out of 191 (12.04%). In 75% of them, NOM failure occurred within 30 h from the trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (p < 0.05).

Conclusion

Providing detection and characterization of parenchymal and vascular traumatic lesions, MDCT plays a crucial role for safe and appropriate guidance of ED management of splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.

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Funding

Dr. Fernanda Garozzo Velloni received a scholarship from Bracco Foundation in order to attend to Progetto Diventerò, in partnership with the Diagnostic Imaging Society of Sao Paulo (Brazil).

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Authors and Affiliations

  1. Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy

    Sergio Margari & Massimo Tonolini

  2. Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy

    Fernanda Garozzo Velloni, Ettore Colombo, Diana Artioli & Angelo Vanzulli

  3. DASA (Diagnósticos da America SA), Sao Paulo, Brazil

    Fernanda Garozzo Velloni

  4. General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy

    Niccolò Ettore Allievi

  5. Department of Surgery, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy

    Fabrizio Sammartano & Osvaldo Chiara

  6. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Angelo Vanzulli

Authors
  1. Sergio Margari
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  2. Fernanda Garozzo Velloni
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  3. Massimo Tonolini
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  4. Ettore Colombo
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  7. Fabrizio Sammartano
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  9. Angelo Vanzulli
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Correspondence to Massimo Tonolini.

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Conflict of interest

Prof. Angelo Vanzulli was a paid speaker at ECR 2014 and 2016 for Bracco Imaging. Dr. Fernanda Garozzo Velloni is a Bracco Foundation alumna, in partnership with Radiological and Diagnostic Imaging Society of Sao Paulo (SPR, Brazil).

All other authors declare that they have no conflict of interest.

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Margari, S., Garozzo Velloni, F., Tonolini, M. et al. Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study. Emerg Radiol 25, 489–497 (2018). https://doi.org/10.1007/s10140-018-1607-x

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  • DOI: https://doi.org/10.1007/s10140-018-1607-x

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