Contemporary Management of Blunt Splenic Trauma in Adults: An Analysis of the Trauma Quality Improvement Program Registry

Arrix L Ryce; Tarek Hanna; Randi Smith; Richard Duszak Jr; Osman Ahmed; Minzhi Xing; Nima Kokabi

doi:10.1016/j.jacr.2024.03.007

Contemporary Management of Blunt Splenic Trauma in Adults: An Analysis of the Trauma Quality Improvement Program Registry

J Am Coll Radiol. 2024 Mar 14:S1546-1440(24)00291-6. doi: 10.1016/j.jacr.2024.03.007. Online ahead of print.

Authors

Arrix L Ryce¹, Tarek Hanna², Randi Smith³, Richard Duszak Jr⁴, Osman Ahmed⁵, Minzhi Xing⁶, Nima Kokabi⁷

Affiliations

¹ Wellstar Kennestone Regional Medical Center, Marietta, Georgia. Electronic address: https://twitter.com/A_Ryce.
² Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. Electronic address: https://twitter.com/ER_Rad_Hanna.
³ Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Marcus Trauma Center, Grady Memorial Hospital, Atlanta, Georgia. Electronic address: https://twitter.com/RandiSmithMD.
⁴ Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi. Electronic address: https://twitter.com/RichDuszak.
⁵ Section of Interventional Radiology, Department of Radiology, University of Chicago Medicine, Chicago, Illinois. Electronic address: https://twitter.com/TheRealDoctorOs.
⁶ Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina.
⁷ Division of Vascular Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: nima_kokabi@med.unc.edu.

PMID: 38492766
DOI: 10.1016/j.jacr.2024.03.007

Abstract

Purpose: The aim of this study was to evaluate the effectiveness of management strategies for blunt splenic injuries in adult patients.

Methods: Patients 18 years and older with blunt splenic injuries registered via the Trauma Quality Improvement Program (2013-2019) were identified. Management strategies initiated within 24 hours of hospital presentation were classified as watchful waiting, embolization, surgery, or combination therapy. Patients were stratified by injury grade. Linear models estimated each strategy's effect on hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality.

Results: Of 81,033 included patients, 86.3%, 10.9%, 2.5%, and 0.3% of patients received watchful waiting, surgery, embolization, and combination therapy, respectively. Among patients with low-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (9.4 days, Q < .001, Cohen's d = .30) and ICU LOS (5.0 days, Q < .001, Cohen's d = .44). Among patients with high-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (8.7 days, Q < .001, Cohen's d = .12) and ICU LOS (4.5 days, Q < .001, Cohen's d = .23). Among patients with low- and high-grade injuries, the odds ratios for in-hospital mortality associated with surgery compared with embolization were 4.02 (Q < .001) and 4.38 (Q < .001), respectively.

Conclusions: Among patients presenting with blunt splenic injuries and compared with surgery, embolization was associated with shorter hospital LOS, shorter ICU LOS, and lower risk for mortality.

Keywords: Spleen; embolization; mortality; surgery; trauma.