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Original article
Predictors of splenic artery embolization as an adjunct to non-operative management of stable blunt splenic injury: a multi-institutional study
  1. Kristin Salottolo1,
  2. Matthew M Carrick2,
  3. Robert M Madayag3,
  4. James Yon4,
  5. Allen Tanner5,
  6. Charles W Mains3,
  7. Andrew Topham6,
  8. Mark Lieser7,
  9. David Acuna6,
  10. David Bar-Or1
  1. 1Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
  2. 2Trauma Services Department, Medical Center of Plano, Plano, Texas, USA
  3. 3Trauma Services Department, St Anthony Hospital, Lakewood, Colorado, USA
  4. 4Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
  5. 5Trauma Services Department, Penrose-St. Francis Health Services, Colorado Springs, Colorado, USA
  6. 6Trauma Services Department, Wesley Medical Center Trauma Services, Wichita, Kansas, USA
  7. 7Trauma Services Department, Research Medical Center, Kansas City, Missouri, USA
  1. Correspondence to Dr David Bar-Or, Swedish Medical Center, Englewood, CO 80113, USA; davidbme49{at}gmail.com

Abstract

Background We sought to identify predictors of splenic artery embolization (SAE) over observation for hemodynamically stable patients with blunt splenic injury (BSI), by Organ Injury Scale (OIS) grade.

Methods This was a multi-institutional retrospective study of all adults (≥18) with BSI who were initially managed non-operatively between 2014 and 2016. Multivariate logistic regression analysis was used to identify predictors of SAE by OIS grade. Covariates included radiographic characteristics (presence/quantity of hemoperitoneum, blush, vascular injury), demographics (age, sex, cause), Injury Severity Score, vital signs, and hemoglobin values. We also examined outcomes of death, length of stay (LOS), intensive care unit (ICU) admission, blood products, and failed non-operative management (NOM).

Results Among 422 patients with stable BSI, 93 (22%) had SAE and 329 (78%) were observed. The rate of SAE increased by grade (p<0.001). In grade I and II BSI, 7% had SAE; significant predictors of SAE were blush (OR: 5.9, p=0.02), moderate or large hemoperitoneum (OR: 3.0, p=0.01), and male sex (OR: 6.3, p=0.05). In grade III BSI, 26% had SAE; significant predictors included moderate or large hemoperitoneum (OR: 3.9, p=0.04), motor vehicle crash (OR: 6.1, p=0.005), and age (OR=1.4, 40% with each decade increase in age, p=0.02). The rate of SAE was 52% for grade IV and 85% for grade V BSI; there were no independent predictors of SAE in either grade. Clinical outcomes were comparable by NOM strategy and grade, except longer LOS with SAE in grades I–III (p<0.05) and longer ICU LOS with SAE in grades I–IV (p<0.05). Only 5 (1.2%) patients failed NOM (4 observation, 1 SAE).

Conclusion These results strongly support SAE consideration for patients with stable grade IV and V BSI even if there are no other high-risk clinical or radiographic findings. For grades I–III, the identified predictors may help refine consideration for SAE.

Level of evidence Level III, retrospective epidemiological study.

  • spleen
  • stable
  • surgical management
  • embolization

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2019-000323

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    Footnotes

    • Contributors All authors contributed to study conception and/or data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

    • Funding Funding was provided by Swedish Medical Center, St Anthony Hospital, Medical City Plano, Penrose-St Francis Medical Center, Wesley Medical Center, and Research Medical Center Kansas City.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study received Institutional Review Board approval at all participating centers and was granted a waiver of consent and HIPAA authorization.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article.