Jenkins Paul, Zhong Jim, Harding James, Sorrell Lexy, Smith Jason, Allgar Victoria, Roobottom Carl
Department of Diagnostic and Interventional Radiology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.
Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
PLoS One. 2025 Jan 8;20(1):e0313138. doi: 10.1371/journal.pone.0313138. eCollection 2025.
The spleen is commonly injured in trauma and this may be managed with a conservative approach, embolisation or splenectomy. There is uncertainty how splenic embolisation fits into the treatment paradigm and the delivery of IR services remains variable.
The primary objectives are to determine if service design significantly affects splenic embolisation (SE) rates in AAST grade 2-5 acute traumatic splenic injuries (ATSI) across the Major Trauma Centres (MTCs) in England and to determine if variation in treatment affects SE outcomes in ATSI.
We will include 5 years of data from traumatic splenic injury patients in the MTCs from 01/01/2016 to 31/12/2020 available from the Trauma Audit and Research Network (TARN) database. Inclusion Criteria will be all patients with ATSI registered with TARN. Those without a CT available to grade radiologically will be excluded. Data available from the TARN database and then correlated with data that will be collected at each MTC, where detail as to the embolisation technique, specific injury pattern, imaging based follow up and patient survival will be available. A short service-based questionnaire will be sent to each centre to establish centre-specific details such as on call rota, IR response activation, reporting practices and capture data around routine decision-making at that site. Data will be collected on an anonymised (REDCap) database. This project will evaluate the impact of service design on embolisation rates and outcomes, as well as evaluating the impact of the variation upon treatment selection and outcomes. Logistic regression will be used to identify factors associated with treatment selection and mortality at 30 days.
脾脏在创伤中常受损伤，对此可采用保守治疗、栓塞或脾切除术。脾脏栓塞在治疗模式中的作用尚不确定，介入放射服务的提供情况也各不相同。
主要目的是确定服务设计是否会显著影响英格兰主要创伤中心（MTC）中AAST 2-5级急性创伤性脾损伤（ATSI）的脾栓塞（SE）率，并确定治疗差异是否会影响ATSI的SE结果。
我们将纳入2016年1月1日至2020年12月31日期间MTC创伤性脾损伤患者的5年数据，这些数据可从创伤审计与研究网络（TARN）数据库获取。纳入标准为所有在TARN注册的ATSI患者。无法获得CT进行放射学分级的患者将被排除。从TARN数据库获取的数据将与各MTC收集的数据相关联，后者将提供栓塞技术、具体损伤模式、基于影像的随访及患者生存情况等详细信息。将向每个中心发送一份基于服务的简短问卷，以确定中心特定的详细信息，如值班轮值表、介入放射响应激活、报告流程，并收集该地点常规决策的数据。数据将收集到一个匿名（REDCap）数据库中。本项目将评估服务设计对栓塞率和结果的影响，以及评估差异对治疗选择和结果的影响。将使用逻辑回归来确定与30天治疗选择和死亡率相关的因素。
