BACKGROUND: The justification and safety of splenic angiographic embolization (SAE) as an adjunct to nonoperative management (NOM) in high-grade splenic injuries are matters of controversy. At Oslo University Hospital-Ulleval, mandatory SAE was introduced in hemodynamically stable Organ Injury Scale (OIS) Grades 3 to 5 injuries in 2002. From October 2008, mandatory SAE was restricted to OIS Grade 4 injuries or higher. The aim of the present study was to evaluate clinical outcome in patients with high-grade splenic injuries and further define the role of SAE. METHODS: All patients 17 years or older with splenic injury admitted from August 1, 2002, to July 31, 2010, were included. Patient charts, computed tomographic scans, and trauma registry data were reviewed. The OIS Grade 3 protocol was amended on October 1, 2008. RESULTS: A total of 296 patients with splenic injuries (mean splenic OIS grade, 3.0) resulted in a 70% attempted NOM rate, with 96% success rate. NOM was attempted in 64 (70%) of 91 patients with Grades 4 and 5 injuries, with a 95% success rate.Comparing OIS Grade 3 injuries admitted before (n = 81) and after (n = 35) October 2008, we found similar admission physiology and Injury Severity Score (ISS). Despite the reduction in SAE rate (from 49% to 26%), the NOM rate remained unchanged, as did NOM failure rate (3% vs. 4%), rate of rebleeding, complications, and mortality. CONCLUSION: A protocol with mandatory SAE in OIS Grades 4 and 5 injuries resulted in an overall 95% success rate among the 70% eligible for NOM. In OIS Grade 3 splenic injuries, mandatory SAE does not seem justified. LEVEL OF EVIDENCE: Therapeutic study, level IV.
BACKGROUND: The justification and safety of splenic angiographic embolization (SAE) as an adjunct to nonoperative management (NOM) in high-grade splenic injuries are matters of controversy. At Oslo University Hospital-Ulleval, mandatory SAE was introduced in hemodynamically stable Organ Injury Scale (OIS) Grades 3 to 5 injuries in 2002. From October 2008, mandatory SAE was restricted to OIS Grade 4 injuries or higher. The aim of the present study was to evaluate clinical outcome in patients with high-grade splenic injuries and further define the role of SAE. METHODS: All patients 17 years or older with splenic injury admitted from August 1, 2002, to July 31, 2010, were included. Patient charts, computed tomographic scans, and trauma registry data were reviewed. The OIS Grade 3 protocol was amended on October 1, 2008. RESULTS: A total of 296 patients with splenic injuries (mean splenic OIS grade, 3.0) resulted in a 70% attempted NOM rate, with 96% success rate. NOM was attempted in 64 (70%) of 91 patients with Grades 4 and 5 injuries, with a 95% success rate.Comparing OIS Grade 3 injuries admitted before (n = 81) and after (n = 35) October 2008, we found similar admission physiology and Injury Severity Score (ISS). Despite the reduction in SAE rate (from 49% to 26%), the NOM rate remained unchanged, as did NOM failure rate (3% vs. 4%), rate of rebleeding, complications, and mortality. CONCLUSION: A protocol with mandatory SAE in OIS Grades 4 and 5 injuries resulted in an overall 95% success rate among the 70% eligible for NOM. In OIS Grade 3 splenic injuries, mandatory SAE does not seem justified. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors: Bahman S Roudsari; Kevin J Psoter; Siddharth A Padia; Matthew J Kogut; Sharon W Kwan Journal: AJR Am J Roentgenol Date: 2014-06 Impact factor: 3.959
Authors: Dominique C Olthof; Pieter Joosse; Patrick M M Bossuyt; Philippe P de Rooij; Loek P H Leenen; Klaus W Wendt; Frank W Bloemers; J Carel Goslings Journal: World J Surg Date: 2016-05 Impact factor: 3.352
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469