S. C. Schonfeld1,2, G. N. Norwood Yost1,2, B. S. Shah1, E. W. Rady1, M. Radomski1,2 1OhioHealth Grant Medical Center, Department Of Trauma Surgery, Columbus, OH, USA 2Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
Introduction: Blunt splenic injuries are common in trauma and can lead to life-threatening hemorrhage. Known treatment strategies include non-operative management (NOM), angioembolization (AE), or operative intervention (OI). This study explored treatments of splenic injuries and outcomes of mortality, complications, intensive care unit (ICU) length of stay (LOS), and total hospital LOS.
Methods: We identified trauma patients that sustained blunt splenic injuries over a 5-year period, 2018 to 2023, at a Level 1 trauma center. Our study included patients ≥18 years old and excluded those who received AE or OI prior to arrival, and those with penetrating injuries. The injury grade was classified by the AAST Spleen Injury Scale (G1-G5). Patients were categorized based on the intervention they received into NOM, AE, and OI. Outcomes compared were mortality, intervention complication, ICU LOS, and total hospital LOS. A subgroup analysis was performed on patients treated with AE looking at all available techniques: selective AE, non-selective coil, non-selective gel foam, or non-selective plug. Additionally, a subgroup analysis was performed on patients undergoing OI.
Results: Overall, 613 patients were included in the study. 391 (63.8%) patients were treated with NOM, 113 (18.4%) with AE, and 117 (19.1%) required OI. Hospital mortality was 3.1%, 3.6%, and 15.5% in patients that underwent NOM, AE, and OI, respectively. Average ICU LOS was 1.8 ± 4.4 (NOM), 2.6 ± 4.2 (AE), and 4.9 ± 8.3 (OI) days and average total hospital LOS was 7.4 ± 10.2 (NOM), 9.5 ± 10.1 (AE), and 12.5 ± 14.3 (OI) days. Complications observed were: 2 NOM failures, 8 AE failures, 8 repeat interventions, 8 delayed re-bleeds, 1 post AE splenic pseudoaneurysm, 1 case of pancreatitis, and 11 readmissions. The majority of injuries were G2 (30.1%) & G3 (29.8%). Most G1 injuries (93.5%) underwent NOM and only 3.8% of G5 injuries underwent NOM. 2.8% of G1 injuries were managed operatively vs 59.6% of G5 injuries required OI. Only one splenorrhaphy was performed and was for a G2 injury. Of the 113 AEs performed, 38 (33.6%) were G3 and 38 (33.9%) were G4 injuries. Non-selective coil was utilized in 55.3% of G3 and 65.8% of G4 splenic injuries.
Conclusion: Most splenic injuries underwent NOM. Of these, most consisted of G3 or lower. Additionally, a strong positive correlation between increasing splenic injury grade and invasive management was noted (R=0.94 for OI and R=0.87 for AE). This suggests that higher grade splenic injuries are more likely to undergo invasive treatments. It was also noted that the more invasive the treatment, the higher likelihood of mortality, increased ICU LOS, and hospital LOS. Only two patients with G3 splenic injuries failed NOM requiring AE. Non-selective coil AE was the most common AE technique. However, 5 out of the 6 AE failures involved non-selective coil use.