A more targeted embolization strategy in blunt splenic trauma reduces procedural volume without increasing splenectomy rates.

作者信息

Marsh Amanda M, Dhillon Navpreet K, Kozar Rosemary A, DuBose Joseph J, Chung C Yvonne, Kundi Rishi, Scalea Thomas M, Harfouche Melike N

机构信息

From the Division of Trauma and Acute Care Surgery (A.M.M.), Chandler Regional Medical Center, Chandler, Arizona; Division of Trauma and Acute Care Surgery (N.K.D.), Riverside University Health System Medical Center, Moreno Valley, California; Department of Surgery (R.A.K., C.Y.C., R.K., T.M.S., M.N.H.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; and Department of Surgery (J.J.D.), Dell Medical School, University of Texas at Austin, Austin, Texas.

出版信息

J Trauma Acute Care Surg. 2025 Jul 17. doi: 10.1097/TA.0000000000004710.

BACKGROUND

The role of splenic angioembolization (SAE) in blunt splenic injury (BSI) has evolved. Revision of the American Association for the Surgery of Trauma (AAST) Splenic Organ Injury Scale BSI classification scheme and increased quality of computed tomography (CT) scans may now identify injuries that no longer benefit from SAE. Our current BSI algorithm recommends mandatory SAE only for high-risk features (pseudoaneurysms ≥10 mm, moderate to large hemoperitoneum, significant parenchymal injury). We hypothesized that this strategy reduced the use of SAE without increasing overall splenectomy or delayed splenectomy rates.

METHODS

We reviewed hemodynamically stable patients with AAST Grades II to V BSI on initial contrast CT scan. Patients who underwent splenectomy prior to CT were excluded. An interrupted time-series analysis was performed with a cutoff of January 2019, when the algorithm was introduced, spanning 3 years before and 5.5 years after (PRE vs. POST). The primary outcomes of interest were changes in rates of SAE, overall splenectomy, and delayed splenectomy >24 hours after admission across the two time periods.

RESULTS

A total of 840 patients met the inclusion criteria, 369 individuals in the PRE group versus 471 in the POST group. The overall rate of SAE decreased from 29% to 17% (p < 0.001) after algorithm implementation without a significant change in rates of overall splenectomy (PRE 30% vs. POST 34%, p = 0.14) or delayed splenectomy (PRE 1.9% vs. POST 3.6%, p = 0.014). In the absence of any significant changes in AAST grade or rates of pseudoaneurysm in the PRE and POST periods, fitted time trends for monthly rates of SAE demonstrate a sharp decline after introduction of the algorithm (p = 0.04).

CONCLUSION

A more selective approach to the use of angioembolization for BSI leads to a reduction in procedural volumes without increasing overall or delayed splenectomy rates. Future research should evaluate conservative approaches of SAE while better defining which high-risk features are mitigated by SAE.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.