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Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To review the management of patients >16 years with blunt splenic injury in a single, UK, major trauma centre and identify whether the following are associated with success or failure of non-operative management with selective use of arterial embolization (NOM ± AE): age, Injury Severity Score (ISS), head injury, haemodynamic instability, massive transfusion, radiological hard signs [contrast extravasation or pseudoaneurysm on the initial computed tomography (CT) scan], grade, and presence of intraparenchymal haematoma or splenic laceration.

Methods

Retrospective, cross-sectional study undertaken between April 2012 and October 2015. Paediatric patients, penetrating splenic trauma, and iatrogenic injuries were excluded. Follow-up was for at least 30 days.

Results

154 patients were included. Median age was 38 years, 77.3% were male, and median ISS was 22. 14/87 (16.1%) patients re-bled following NOM in a median of 2.3 days (IQR 0.8–3.6 days). 8/28 (28.6%) patients re-bled following AE in a median of 2.0 days (IQR 1.3–3.7 days). Grade III–V injuries are a significant predictor of the failure of NOM ± AE (OR 15.6, 95% CI 3.1–78.9, p = 0.001). No grade I injuries and only 3.3% grade II injuries re-bled following NOM ± AE. Age ≥55 years, ISS, radiological hard signs, and haemodynamic instability are not significant predictors of the failure of NOM ± AE, but an intraparenchymal or subcapsular haematoma increases the likelihood of failure 11-fold (OR 10.9, 95% CI 2.2–55.1, p = 0.004).

Conclusions

Higher grade injuries (III–V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM ± AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24 h with appropriate advice.

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Authors and Affiliations

  1. East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK

    Louise Morris, Stephen Spreadborough, Waleed Al-Obaydi, Marta D’Auria, Hilary White & Adam J. Brooks

  2. University Hospital South Manchester, Southmoor Road, Wythenshawe, M23 9LT, Manchester, UK

    Stella R. Smith

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  1. Stella R. Smith
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  2. Louise Morris
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Correspondence to Stella R. Smith.

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Previous presentation of this work

European Society of Trauma and Emergency Surgery Congress, Vienna 2016 oral presentation. Reference 0197: Management of Blunt Splenic Injury: a retrospective review of practice and outcomes at a UK major trauma centre.

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Smith, S.R., Morris, L., Spreadborough, S. et al. Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study. Eur J Trauma Emerg Surg 44, 397–406 (2018). https://doi.org/10.1007/s00068-017-0807-5

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