BACKGROUND: The literature on blunt splenic trauma provides little evidence-based direction for nonsurgical management. The appropriate role of computed tomography (CT) after initial diagnosis, activity restriction and follow-up are continuing controversies. METHODS: Active EAST members were surveyed regarding in-hospital management and follow-up of patients with isolated and near-isolated blunt splenic injury. Analyses were performed using descriptive and correlational statistics. RESULTS: A 38.4% response rate was obtained. 82.6% of respondents practiced at a Level I trauma centers. 97% of respondents considered hemodynamic instability as the primary indication for immediate splenectomy. 71.6% of respondents preferred ultrasound for initial imaging in hemodynamically stable patients. One-third of respondents admitted stable Grade I patients to monitored settings. 85.5% would not routinely perform predischarge abdominal CT scan in the absence of clinical deterioration, extravasation on initial CT or high-grade injury. Activity restriction varied by grade (table). The majority of respondents (78.1%) relied on clinical judgment alone for activity recommendations in lower grades of injury while a higher reliance on CT was used for Grades IV and V (49.8%). CONCLUSIONS: Despite the lack of evidence-based guidelines, many in-hospital and follow-up practices were reasonably consistent. However, some important contradictions were noted (such as monitoring very low risk patients and not intervening in patients with contrast blush). Activity restrictions were usually based on clinical judgment supplemented by CT at the highest grades of injury. Lack of evidence-based guidelines and high reliance on clinical judgment underscore the need for a well-designed prospective study to define optimal management and follow-up.
BACKGROUND: The literature on blunt splenic trauma provides little evidence-based direction for nonsurgical management. The appropriate role of computed tomography (CT) after initial diagnosis, activity restriction and follow-up are continuing controversies. METHODS: Active EAST members were surveyed regarding in-hospital management and follow-up of patients with isolated and near-isolated blunt splenic injury. Analyses were performed using descriptive and correlational statistics. RESULTS: A 38.4% response rate was obtained. 82.6% of respondents practiced at a Level I trauma centers. 97% of respondents considered hemodynamic instability as the primary indication for immediate splenectomy. 71.6% of respondents preferred ultrasound for initial imaging in hemodynamically stable patients. One-third of respondents admitted stable Grade I patients to monitored settings. 85.5% would not routinely perform predischarge abdominal CT scan in the absence of clinical deterioration, extravasation on initial CT or high-grade injury. Activity restriction varied by grade (table). The majority of respondents (78.1%) relied on clinical judgment alone for activity recommendations in lower grades of injury while a higher reliance on CT was used for Grades IV and V (49.8%). CONCLUSIONS: Despite the lack of evidence-based guidelines, many in-hospital and follow-up practices were reasonably consistent. However, some important contradictions were noted (such as monitoring very low risk patients and not intervening in patients with contrast blush). Activity restrictions were usually based on clinical judgment supplemented by CT at the highest grades of injury. Lack of evidence-based guidelines and high reliance on clinical judgment underscore the need for a well-designed prospective study to define optimal management and follow-up.
Authors: Cornelis H van der Vlies; Dominique C Olthof; Menno Gaakeer; Kees J Ponsen; Otto M van Delden; J Carel Goslings Journal: Int J Emerg Med Date: 2011-07-27