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Trends in Blunt Splenic Injury Management: The Rise of Splenic Artery Embolization.

Authors
  • Marsh, D'Arcy1
  • Day, Marilyn1
  • Gupta, Amit2
  • Huang, Emily C1
  • Hou, Wei3
  • Vosswinkel, James A1
  • Jawa, Randeep S4
  • 1 Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York.
  • 2 Department of Radiology, Stony Brook University School of Medicine, Stony Brook New York.
  • 3 Department of Family, Population and Preventative Medicine, Stony Brook University School of Medicine, Stony Brook, New York.
  • 4 Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York. Electronic address: [email protected]
Type
Published Article
Journal
Journal of Surgical Research
Publisher
Elsevier
Publication Date
Sep 01, 2021
Volume
265
Pages
86–94
Identifiers
DOI: 10.1016/j.jss.2021.02.038
PMID: 33894453
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Splenic injury is common in blunt trauma. We sought to evaluate the injury characteristics and outcomes of BSI admitted over a 10-y period to an academic trauma center. A retrospective review of adult blunt splenic injury patients admitted between January 2009 and September 2018. The 423 patients meeting inclusion criteria were divided by management: Observational (OBS, n = 261), splenic surgery (n = 114 including 4 splenorrhaphy patients), SAE (n = 43), and multiple treatment modalities (3 had SAE followed by surgery and 2 OBS patients underwent splenic surgery at readmission). The most common mechanism of injury was motor vehicle collision (47.8%). The median ISS (OBS 17, SAE 22, Surgery 34) and spleen AIS (OBS 2, SAE 3, Surgery 4) were significantly different. Complication rates (OBS 21.8%, SAE 9.3%, Surgery 45.6%) rates were significantly different, but mortality (OBS 7.3%, SAE 2.3%, Surgery 13.2%), discharge to home and readmission rates were not. Additional abdominal injuries were identified in 26.3% of the surgery group and 2.7% of OBS group. SAE rate increased from 3.0% to 28%; median spleen AIS remained 2-3. Thirty-five patients expired; 28 had severe head, chest, and/or extremity injuries (AIS ≥4). SAE rates increased over time. Splenorrhaphy rates were low. SAE was associated with relatively low rates of mortality and complications in appropriately selected patients. Copyright © 2021. Published by Elsevier Inc.

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