NDLI: Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Duchesne, Juan C. Simmons, Jon D. Schmieg, Robert E. McSwain, Norman E. Bellows, Charles F.
Description	Country affiliation: United States Author Affiliation: Duchesne JC ( Division of Trauma and Critical Care Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA. jduchesn@tulane.edu)
Abstract	BACKGROUND: Although splenic angioembolization (SAE) has been introduced and adopted in many trauma centers, the appropriate selection for and utility of SAE in trauma patients remains under debate. This study examined the outcomes of proximal SAE as part of a management algorithm for adult traumatic splenic injury compared with splenectomy. METHODS: A retrospective cohort analysis was performed on all hemodynamically stable (HDS) blunt trauma patients with isolated splenic injury and computed tomographic (CT) evidence of active contrast extravasation that presented to a level 1 Trauma Center over a period of 5 years. The cohorts were defined by two separate 30 month periods and included 78 patients seen before (group I) and 76 patients seen after (group II) the introduction of an institutional SAE protocol. Demographics, splenic injury grade, and outcomes of the two groups were compared using Student's t test, or chi2 test. Analysis was by intention-to-treat. RESULTS: Six hundred eighty-two patients with blunt splenic injury were identified; 154 patients (29%) were HDS with CT evidence of active contrast extravasation. Group I (n = 78) was treated with splenectomy and group II (n = 76) was treated with proximal SAE. There was no difference in age (33 +/- 14 vs. 37 +/- 17 years), Injury Severity Score (31 +/- 13 vs. 29 +/- 11), or mortality (18% vs. 15%) between the two groups. However, the incidence of Adult Respiratory Distress Syndrome (ARDS) was 4-fold higher in those patients that underwent proximal SAE compared with those that underwent splenectomy (22% vs. 5%, p = 0.002). Twenty two patients failed nonoperative management (NOM) after SAE. This failure appeared to be directly related to the grade of splenic organ injury (grade I and II: 0%; grade III: 24%; grade IV: 53%; and grade V: 100%). CONCLUSION: Introduction of proximal SAE in NOM of HDS splenic trauma patients with active extravasation did not alter mortality rates at a Level 1 Trauma Center. Increased incidence of ARDS and association of failure of NOM with higher splenic organ injury score identify areas for cautionary application of proximal SAE in the more severely injured trauma patient population. Better patient selection guidelines for proximal SAE are needed. Without these guidelines, outcomes from SAE will still lack transparency.
File Format	HTM / HTML
ISSN	00225282
Issue Number	6
Volume Number	65
e-ISSN	15298809
Journal	The Journal of Trauma: Injury, Infection, and Critical Care
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-12-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Therapy Cross-sectional Studies Comparative Study Angiography Blood Supply Humans Middle Aged Abdominal Injuries Male Embolization, Therapeutic Epidemiology Journal Article Wounds, Nonpenetrating Incidence Splenectomy Young Adult Etiology Treatment Failure Adult Female Retrospective Studies Postoperative Complications Injuries Spleen Respiratory Distress Syndrome, Adult Mortality Extravasation Of Diagnostic And Therapeutic Materials Tomography, X-ray Computed Survival Rate Discipline Traumatology Algorithms Adolescent Cohort Studies
Content Type	Text
Resource Type	Article
Subject	Surgery Critical Care and Intensive Care Medicine

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