Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study

Authors

• Kristen Spoor, Prisma Health Upstate
• John David Cull, Prisma Health Upstate
• Banan W. Otaibi, Pennsylvania State University
• Joshua P. Hazelton, Pennsylvania State University
• John Chipko
• Jessica Reynolds
• Sam Fugate
• Claire Pederson
• Linda B. Zier
• Lewis E. Jacobson
• Jamie M. Williams
• Thomas S. Easterday
• Saskya Byerly
• Caleb Mentzer
• Edward Hawke
• Danielle C. Cullinane
• Julianne B. Ontengco
• Nikolay Bugaev
• Madison LeClair
• Pascal Udekwu
• Cooper Josephs
• Matthew Noorbaksh
• James Babowice
• Catherine Garrison Velopulos
• Shane Urban
• Anna Goldenberg
• Gaby Ghobrial
• John M. Pickering
• Steven D. Quarfordt
• Alia F. Aunchman
• Aimee K. LaRiccia
• Chance Spalding
• Richard D. Catalano
• Jordan E. Basham
• Philip M. Edmundson
• Jeffry Nahmias
• Erika Tay
• Scott H. Norwood
• Katelyn Meadows, University of Texas at Tyler
• Yee Wong
• Clarie Hardman

Document Type

Article

Publication Date

Fall 12-25-2023

Abstract

Objectives There is little evidence guiding the management of grade I–II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I–II splenic injuries with CB in hemodynamically stable patients. Methods A multicenter, retrospective cohort study examining all grade I–II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined the failure rate of NOM for grade I versus grade II splenic injuries. We then performed bivariate comparisons of patients who failed NOM with those who did not. Results A total of 145 patients were included. Median Injury Severity Score was 17. The combined rate of failure for grade I–II injuries was 20.0%. There was no statistical difference in failure of NOM between grade I and II injuries with CB (18.2% vs 21.1%, p>0.05). Patients who failed NOM had an increased median hospital length of stay (p=0.024) and increased need for blood transfusion (p=0.004) and massive transfusion (p=0.030). Five patients (3.4%) died and 96 (66.2%) were discharged home, with no differences between those who failed and those who did not fail NOM (both p>0.05). Conclusion NOM of grade I–II splenic injuries with CB fails in 20% of patients. © Author(s) (or their employer(s))

Description

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Persistant Identifier

http://hdl.handle.net/10950/5176

Publisher

BMJ Publishing Group

Recommended Citation

Spoor, Kristen; Cull, John David; Otaibi, Banan W.; Hazelton, Joshua P.; Chipko, John; Reynolds, Jessica; Fugate, Sam; Pederson, Claire; Zier, Linda B.; Jacobson, Lewis E.; Williams, Jamie M.; Easterday, Thomas S.; Byerly, Saskya; Mentzer, Caleb; Hawke, Edward; Cullinane, Danielle C.; Ontengco, Julianne B.; Bugaev, Nikolay; LeClair, Madison; Udekwu, Pascal; Josephs, Cooper; Noorbaksh, Matthew; Babowice, James; Velopulos, Catherine Garrison; Urban, Shane; Goldenberg, Anna; Ghobrial, Gaby; Pickering, John M.; Quarfordt, Steven D.; Aunchman, Alia F.; LaRiccia, Aimee K.; Spalding, Chance; Catalano, Richard D.; Basham, Jordan E.; Edmundson, Philip M.; Nahmias, Jeffry; Tay, Erika; Norwood, Scott H.; Meadows, Katelyn; Wong, Yee; and Hardman, Clarie, "Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study" (2023). School of Medicine Faculty Publications and Presentations. Paper 28.