R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.
The University of Texas at Austin Dell Medical School, Austin, TX, USA.
Am Surg. 2023 Jul;89(7):3214-3216. doi: 10.1177/00031348231157844. Epub 2023 Feb 17.
This retrospective, single-site study at a level I trauma center (2016-2021) sought to determine whether repeat CT had an impact on clinical decision making after splenic angioembolization following blunt splenic trauma (grades II-V). The primary outcome was need for intervention after subsequent imaging (defined as angioembolization and/or splenectomy) by high- or low-grade injury. Of the 400 individuals examined, 78 (19.5%) underwent intervention after repeat CT, from which 17% were in the low-grade group (grades II and III) and 22% were in the high-grade group (grades IV and V). Individuals in the high-grade group were 3.6 times more likely to undergo delayed splenectomy than those in the low-grade group ( = .006). Delayed intervention after surveillance imaging in blunt splenic injury is driven mostly by the identification of new vascular lesions and leads to greater rates of splenectomy in high-grade injuries. Surveillance imaging should be considered for all AAST injury grades II or higher.
这项回顾性、单站点研究在一级创伤中心进行（2016-2021 年），旨在确定在钝性脾外伤（II-V 级）后进行脾动脉栓塞后重复 CT 是否会影响临床决策。主要结局是后续影像学检查（定义为血管栓塞和/或脾切除术）后需要干预的情况，根据高或低损伤分级。在接受检查的 400 人中，78 人（19.5%）在重复 CT 后进行了干预，其中 17%为低级别组（II 级和 III 级），22%为高级别组（IV 级和 V 级）。高级别组发生延迟性脾切除术的可能性是低级别组的 3.6 倍（ =.006）。在钝性脾损伤的监测成像后延迟干预主要是由于新血管病变的识别，并导致高级别损伤中脾切除术的发生率更高。对于 AAST 损伤等级 II 级或更高的所有患者，都应考虑进行监测成像。
