BACKGROUND: The use of angiography (ANGIO) in the management of high-grade (Abbreviated Injury Scale [AIS] score > 2) blunt splenic injury (BSI) remains controversial. We aimed to compare patient characteristics of those treated at high and low ANGIO centers, to compare the characteristics of the patients undergoing ANGIO at high and low ANGIO centers, and to determine the relationship among hospital ANGIO use, the timing of angiography, and splenectomy after angiography. METHODS: The National Trauma Data Bank was used to identify patients 18 years and older with BSI (AIS score > 2) treated at Level I or II trauma centers that admitted at least 10 patients with high-grade BSI from 2007 to 2010. Timing of ANGIO and splenectomy was determined. Hospitals were stratified based on ANGIO use rates into three groups: 0% (no ANGIO); 1% to 19.9% (low ANGIO); and more than 20% (high ANGIO). Hierarchical logistic regression was used to control for patient clustering at the hospital level and to determine factors associated with splenectomy. Cox regression with ANGIO as a time-varying covariate was also used. RESULTS: A total of 10,405 met inclusion criteria. After adjusting for hospital case mix, low ANGIO (odds ratio, 1.02; 95% confidence interval [CI], 0.70-1.48) and no ANGIO (odds ratio, 0.88; 95% CI, 0.59-1.31) centers showed no difference with regard to splenectomy compared with high ANGIO centers. ANGIO (Hazard Ratio = 0.52; 95% CI, 0.41-0.65) was protective of splenectomy on Cox regression analysis, taking into account ANGIO timing relative to splenectomy. CONCLUSION: There were no differences in splenectomy rates after adjusting for case mix at high and low ANGIO centers. Early ANGIO, irrespective of hospital ANGIO use, is associated with splenic salvage. LEVEL OF EVIDENCE: Therapeutic study, level III.
BACKGROUND: The use of angiography (ANGIO) in the management of high-grade (Abbreviated Injury Scale [AIS] score > 2) blunt splenic injury (BSI) remains controversial. We aimed to compare patient characteristics of those treated at high and low ANGIO centers, to compare the characteristics of the patients undergoing ANGIO at high and low ANGIO centers, and to determine the relationship among hospital ANGIO use, the timing of angiography, and splenectomy after angiography. METHODS: The National Trauma Data Bank was used to identify patients 18 years and older with BSI (AIS score > 2) treated at Level I or II trauma centers that admitted at least 10 patients with high-grade BSI from 2007 to 2010. Timing of ANGIO and splenectomy was determined. Hospitals were stratified based on ANGIO use rates into three groups: 0% (no ANGIO); 1% to 19.9% (low ANGIO); and more than 20% (high ANGIO). Hierarchical logistic regression was used to control for patient clustering at the hospital level and to determine factors associated with splenectomy. Cox regression with ANGIO as a time-varying covariate was also used. RESULTS: A total of 10,405 met inclusion criteria. After adjusting for hospital case mix, low ANGIO (odds ratio, 1.02; 95% confidence interval [CI], 0.70-1.48) and no ANGIO (odds ratio, 0.88; 95% CI, 0.59-1.31) centers showed no difference with regard to splenectomy compared with high ANGIO centers. ANGIO (Hazard Ratio = 0.52; 95% CI, 0.41-0.65) was protective of splenectomy on Cox regression analysis, taking into account ANGIO timing relative to splenectomy. CONCLUSION: There were no differences in splenectomy rates after adjusting for case mix at high and low ANGIO centers. Early ANGIO, irrespective of hospital ANGIO use, is associated with splenic salvage. LEVEL OF EVIDENCE: Therapeutic study, level III.
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
Authors: Graeme M Rosenberg; Lisa Knowlton; Charlotte Rajasingh; Yingjie Weng; Paul M Maggio; David A Spain; Kristan L Staudenmayer Journal: JAMA Surg Date: 2017-12-01 Impact factor: 14.766