A survey of American Association for the Surgery of Trauma member practices in the management of blunt splenic injury

J Trauma. 2011 May;70(5):1026-31. doi: 10.1097/TA.0b013e318217080c.


Objective: Conflicting data exist regarding pseudoaneurysm screening (PSA-S), initial angioembolization (IE), deep venous thrombosis prophylaxis (DVT-P), and activity limitation after hemodynamically stable blunt splenic injury (BSI). To determine whether there was consensus regarding BSI management, the multi-institutional trial committee of the American Association for the Surgery of Trauma (AAST) approved a survey of member practice patterns regarding BSI management.

Methods: Over 2 months, AAST members were invited to participate in an online survey. Practice patterns and attitudes surrounding PSA-S, IE, DVT-P, and activity limitation after BSI were determined.

Results: The response rate was 37.5%. Practice patterns varied by injury grade. Observation only was thought appropriate for grades I (94.4%) and II (84.6%) injuries. For grades III to V injuries, fewer and fewer respondents felt observation only was appropriate. PSA-S was the most commonly used strategy for grades IV and V injuries (32.7% and 28.2%), and IE was thought to be appropriate by 23.5% of respondents for grade IV injuries and 25.5% of respondents with grade V injuries. Thirty percent of respondents felt that no DVT-P was indicated for adult patients with BSI. Recommendations regarding return to full activity varied by perceived risk to the patient and by injury grade.

Conclusions: There is considerable variation in the opinions of AAST members regarding BSI management, particularly for high-grade injuries. These results will aid in the design of prospective observational and random trials to determine optimal BSI management.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Abdominal Injuries / diagnosis
  • Abdominal Injuries / epidemiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Societies, Medical / statistics & numerical data*
  • Spleen / injuries*
  • Splenectomy / statistics & numerical data*
  • Surveys and Questionnaires*
  • Trauma Centers / statistics & numerical data*
  • Trauma Severity Indices
  • United States / epidemiology
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / epidemiology*