Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience

Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience

•A 13-year retrospective cohort study of hemodynamincally stable adult blunt splenic injury (BSI) patients from a level 1 trauma centre in Adelaide, South Australia, Australia.•208 out of 365 patients met the inclusion criteria, with 26% undergoing splenic artery angioembolisation (ASE) within 24 h...

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Veröffentlicht in:Injury 2022-05, Vol.53 (5), p.1620-1626
Hauptverfasser: Han, Jennie, Dudi-Venkata, Nagendra N, Jolly, Samantha, Ting, Ying Yang, Lu, Ha, Thomas, Meredith, Dobbins, Christopher
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Blunt abdominal trauma
Non-operative management
Outcomes
Splenic angioembolization
Splenic injury
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container_issue 5
container_start_page 1620
container_title Injury
container_volume 53
creator Han, Jennie
Dudi-Venkata, Nagendra N
Jolly, Samantha
Ting, Ying Yang
Lu, Ha
Thomas, Meredith
Dobbins, Christopher
description •A 13-year retrospective cohort study of hemodynamincally stable adult blunt splenic injury (BSI) patients from a level 1 trauma centre in Adelaide, South Australia, Australia.•208 out of 365 patients met the inclusion criteria, with 26% undergoing splenic artery angioembolisation (ASE) within 24 h and 45% non-operative management (NOM) only.•There was no difference in the overall success rates for each modality of primary management, though patients managed with ASE were older with higher grade of splenic injury and increased rates of haemo-peritoneum and contrast blush.•Grade III splenic injury patients managed with ASE had no failures compared to the NOM group with a significant reduction in length of hospital stay (LOS).•Overall, the ASE group had a significantly shorter LOS than the NOM group (10.0 vs 16.0 days, p
doi_str_mv 10.1016/j.injury.2021.12.043
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Splenic injuries are the most common visceral injury following blunt abdominal trauma. Increasingly, non-operative management (NOM) and the use of adjunctive splenic angioembolization (ASE) is favoured over operative management (OM) for the hemodynamically stable patient. However, clinical predictors for successful NOM, particularly the role of ASE as an adjunct, remain poorly defined. This study aims to evaluate the outcomes of patients undergoing ASE vs NOM. A retrospective clinical audit was performed of all patients admitted with blunt splenic injury (BSI) from January 2005 to January 2018 at the Royal Adelaide Hospital. The primary outcome was ASE or NOM failure rate. Secondary outcomes were grade of splenic injury, Injury Severity Score (ISS), length of hospital stay (LOS), and delayed OM or re-angioembolization rates. Of 208 patients with BSI, 60 (29%) underwent OM, 54 (26%) ASE, and 94 (45%) NOM only. Patients were predominantly male 165 (79%), with a median age of 33 (IQR 24–51) years. The median ISS was 29 (20–38). There was no difference in the overall success rates for each modality of primary management (48 (89%) ASE vs 77 (82%) NOM, p = 0.374), though patients managed with ASE were older (38 vs 30 years, p = 0.029), had higher grade of splenic injury (grade ≥ IV 42 (78%) vs 8 (8.5%), p&lt;0.001), with increased rates of haemo-peritoneum (46 (85%) vs 51 (54%), p&lt;0.001) and contrast blush (42 (78%) vs 2 (2%), p&lt;0.001). However, for grade III splenic injury, patients managed with ASE had a trend towards better outcome with no failures when compared to the NOM group (0 (0%) vs 8 (35%), p = 0.070) with a significant reduction in LOS (7.2 vs 10.8 days, p = 0.042). Furthermore, the ASE group overall had a significantly shorter LOS compared to the NOM group (10.0 vs 16.0 days, p&lt;0.001). ASE as an adjunct to NOM significantly reduces the length of stay in BSI patients and is most successful in managing AAST grade III injuries.</description><identifier>ISSN: 0020-1383</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2021.12.043</identifier><identifier>PMID: 34991862</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Blunt abdominal trauma ; Non-operative management ; Outcomes ; Splenic angioembolization ; Splenic injury</subject><ispartof>Injury, 2022-05, Vol.53 (5), p.1620-1626</ispartof><rights>2021 Elsevier Ltd</rights><rights>Copyright © 2021 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-136c3a07848d6737ac55581a19c6c8f20cbfe2d01e50340cb7b87e10366a34863</citedby><cites>FETCH-LOGICAL-c362t-136c3a07848d6737ac55581a19c6c8f20cbfe2d01e50340cb7b87e10366a34863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.injury.2021.12.043$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34991862$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Han, Jennie</creatorcontrib><creatorcontrib>Dudi-Venkata, Nagendra N</creatorcontrib><creatorcontrib>Jolly, Samantha</creatorcontrib><creatorcontrib>Ting, Ying Yang</creatorcontrib><creatorcontrib>Lu, Ha</creatorcontrib><creatorcontrib>Thomas, Meredith</creatorcontrib><creatorcontrib>Dobbins, Christopher</creatorcontrib><title>Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience</title><title>Injury</title><addtitle>Injury</addtitle><description>•A 13-year retrospective cohort study of hemodynamincally stable adult blunt splenic injury (BSI) patients from a level 1 trauma centre in Adelaide, South Australia, Australia.•208 out of 365 patients met the inclusion criteria, with 26% undergoing splenic artery angioembolisation (ASE) within 24 h and 45% non-operative management (NOM) only.•There was no difference in the overall success rates for each modality of primary management, though patients managed with ASE were older with higher grade of splenic injury and increased rates of haemo-peritoneum and contrast blush.•Grade III splenic injury patients managed with ASE had no failures compared to the NOM group with a significant reduction in length of hospital stay (LOS).•Overall, the ASE group had a significantly shorter LOS than the NOM group (10.0 vs 16.0 days, p&lt;0.001). Splenic injuries are the most common visceral injury following blunt abdominal trauma. Increasingly, non-operative management (NOM) and the use of adjunctive splenic angioembolization (ASE) is favoured over operative management (OM) for the hemodynamically stable patient. However, clinical predictors for successful NOM, particularly the role of ASE as an adjunct, remain poorly defined. This study aims to evaluate the outcomes of patients undergoing ASE vs NOM. A retrospective clinical audit was performed of all patients admitted with blunt splenic injury (BSI) from January 2005 to January 2018 at the Royal Adelaide Hospital. The primary outcome was ASE or NOM failure rate. Secondary outcomes were grade of splenic injury, Injury Severity Score (ISS), length of hospital stay (LOS), and delayed OM or re-angioembolization rates. Of 208 patients with BSI, 60 (29%) underwent OM, 54 (26%) ASE, and 94 (45%) NOM only. Patients were predominantly male 165 (79%), with a median age of 33 (IQR 24–51) years. The median ISS was 29 (20–38). There was no difference in the overall success rates for each modality of primary management (48 (89%) ASE vs 77 (82%) NOM, p = 0.374), though patients managed with ASE were older (38 vs 30 years, p = 0.029), had higher grade of splenic injury (grade ≥ IV 42 (78%) vs 8 (8.5%), p&lt;0.001), with increased rates of haemo-peritoneum (46 (85%) vs 51 (54%), p&lt;0.001) and contrast blush (42 (78%) vs 2 (2%), p&lt;0.001). However, for grade III splenic injury, patients managed with ASE had a trend towards better outcome with no failures when compared to the NOM group (0 (0%) vs 8 (35%), p = 0.070) with a significant reduction in LOS (7.2 vs 10.8 days, p = 0.042). Furthermore, the ASE group overall had a significantly shorter LOS compared to the NOM group (10.0 vs 16.0 days, p&lt;0.001). ASE as an adjunct to NOM significantly reduces the length of stay in BSI patients and is most successful in managing AAST grade III injuries.</description><subject>Blunt abdominal trauma</subject><subject>Non-operative management</subject><subject>Outcomes</subject><subject>Splenic angioembolization</subject><subject>Splenic injury</subject><issn>0020-1383</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9UUuOEzEQtRCICTNzA4S8ZJPGn47b2SBFI37SSCxmWFtudzVx5E-w3RHNijtwEq7ESXAmgeWsqsp6H1c9hF5S0lBCxZtdY8NuSnPDCKMNZQ1p-RO0oLJbLwkT3VO0IISRJeWSX6AXOe8IoR3h_Dm64O16TaVgC_T7bu8gWIN1KpBmDL6Pzv7QxcaArd-neICM41RM9LXRYcADmAQ616lsAVf217LFccS56BnbgLfg4zAH7a3Rzs3H994B7t0UCs5nu4e_26rx5-cvvKkqB3CY4s2US9LO6oDvk568xgZCSYDh-x4qPhi4Qs9G7TJcn-sl-vL-3f3Nx-Xt5w-fbja3S8MFK3VtYbgmnWzlIDreabNarSTVdG2EkSMjph-BDYTCivC2Tl0vO6CEC6F5KwW_RK9PuvUG3ybIRXmbDTinA8QpKyaoZJx0TFZoe4KaFHNOMKp9sl6nWVGijmGpnTqFpY5hKcpUDavSXp0dpt7D8J_0L50KeHsCQN3zYCGpbB5uMNgEpqgh2scd_gLZgqxt</recordid><startdate>202205</startdate><enddate>202205</enddate><creator>Han, Jennie</creator><creator>Dudi-Venkata, Nagendra N</creator><creator>Jolly, Samantha</creator><creator>Ting, Ying Yang</creator><creator>Lu, Ha</creator><creator>Thomas, Meredith</creator><creator>Dobbins, Christopher</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202205</creationdate><title>Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience</title><author>Han, Jennie ; Dudi-Venkata, Nagendra N ; Jolly, Samantha ; Ting, Ying Yang ; Lu, Ha ; Thomas, Meredith ; Dobbins, Christopher</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-136c3a07848d6737ac55581a19c6c8f20cbfe2d01e50340cb7b87e10366a34863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Blunt abdominal trauma</topic><topic>Non-operative management</topic><topic>Outcomes</topic><topic>Splenic angioembolization</topic><topic>Splenic injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Han, Jennie</creatorcontrib><creatorcontrib>Dudi-Venkata, Nagendra N</creatorcontrib><creatorcontrib>Jolly, Samantha</creatorcontrib><creatorcontrib>Ting, Ying Yang</creatorcontrib><creatorcontrib>Lu, Ha</creatorcontrib><creatorcontrib>Thomas, Meredith</creatorcontrib><creatorcontrib>Dobbins, Christopher</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Han, Jennie</au><au>Dudi-Venkata, Nagendra N</au><au>Jolly, Samantha</au><au>Ting, Ying Yang</au><au>Lu, Ha</au><au>Thomas, Meredith</au><au>Dobbins, Christopher</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience</atitle><jtitle>Injury</jtitle><addtitle>Injury</addtitle><date>2022-05</date><risdate>2022</risdate><volume>53</volume><issue>5</issue><spage>1620</spage><epage>1626</epage><pages>1620-1626</pages><issn>0020-1383</issn><eissn>1879-0267</eissn><abstract>•A 13-year retrospective cohort study of hemodynamincally stable adult blunt splenic injury (BSI) patients from a level 1 trauma centre in Adelaide, South Australia, Australia.•208 out of 365 patients met the inclusion criteria, with 26% undergoing splenic artery angioembolisation (ASE) within 24 h and 45% non-operative management (NOM) only.•There was no difference in the overall success rates for each modality of primary management, though patients managed with ASE were older with higher grade of splenic injury and increased rates of haemo-peritoneum and contrast blush.•Grade III splenic injury patients managed with ASE had no failures compared to the NOM group with a significant reduction in length of hospital stay (LOS).•Overall, the ASE group had a significantly shorter LOS than the NOM group (10.0 vs 16.0 days, p&lt;0.001). Splenic injuries are the most common visceral injury following blunt abdominal trauma. Increasingly, non-operative management (NOM) and the use of adjunctive splenic angioembolization (ASE) is favoured over operative management (OM) for the hemodynamically stable patient. However, clinical predictors for successful NOM, particularly the role of ASE as an adjunct, remain poorly defined. This study aims to evaluate the outcomes of patients undergoing ASE vs NOM. A retrospective clinical audit was performed of all patients admitted with blunt splenic injury (BSI) from January 2005 to January 2018 at the Royal Adelaide Hospital. The primary outcome was ASE or NOM failure rate. Secondary outcomes were grade of splenic injury, Injury Severity Score (ISS), length of hospital stay (LOS), and delayed OM or re-angioembolization rates. Of 208 patients with BSI, 60 (29%) underwent OM, 54 (26%) ASE, and 94 (45%) NOM only. Patients were predominantly male 165 (79%), with a median age of 33 (IQR 24–51) years. The median ISS was 29 (20–38). There was no difference in the overall success rates for each modality of primary management (48 (89%) ASE vs 77 (82%) NOM, p = 0.374), though patients managed with ASE were older (38 vs 30 years, p = 0.029), had higher grade of splenic injury (grade ≥ IV 42 (78%) vs 8 (8.5%), p&lt;0.001), with increased rates of haemo-peritoneum (46 (85%) vs 51 (54%), p&lt;0.001) and contrast blush (42 (78%) vs 2 (2%), p&lt;0.001). However, for grade III splenic injury, patients managed with ASE had a trend towards better outcome with no failures when compared to the NOM group (0 (0%) vs 8 (35%), p = 0.070) with a significant reduction in LOS (7.2 vs 10.8 days, p = 0.042). Furthermore, the ASE group overall had a significantly shorter LOS compared to the NOM group (10.0 vs 16.0 days, p&lt;0.001). ASE as an adjunct to NOM significantly reduces the length of stay in BSI patients and is most successful in managing AAST grade III injuries.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>34991862</pmid><doi>10.1016/j.injury.2021.12.043</doi><tpages>7</tpages></addata></record>
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source ScienceDirect Journals (5 years ago - present)
subjects Blunt abdominal trauma
Non-operative management
Outcomes
Splenic angioembolization
Splenic injury
title Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience
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