Serial CT for Nonoperatively Managed Splenic Injuries
Introduction The role of serial computed tomography (CT) in the nonoperative management of blunt splenic injuries (NOMSIs) remains unclear. The purpose of the study was to determine the utility of serial CT of Grade 2-5 NOMSI in the modern era. Methods Blunt splenic injuries were identified over a 3...
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| Veröffentlicht in: | The American surgeon 2022-07, Vol.88 (7), p.1504-1509 |
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| container_title | The American surgeon |
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| creator | Byerly, Saskya E. Jones, Michael D. Lenart, Emily K. Seger, Catherine P. Filiberto, Dina M. Lewis, Richard H. Kerwin, Andrew J. Magnotti, Louis J. |
| description | Introduction
The role of serial computed tomography (CT) in the nonoperative management of blunt splenic injuries (NOMSIs) remains unclear. The purpose of the study was to determine the utility of serial CT of Grade 2-5 NOMSI in the modern era.
Methods
Blunt splenic injuries were identified over a 3.5-year period, ending in 6/2020. Our institutional protocol for NOMSI mandates a repeat 24-hour CT for Grade 2-5 injuries. Patients age |
| doi_str_mv | 10.1177/00031348221082285 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2644363646</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_00031348221082285</sage_id><sourcerecordid>2676504598</sourcerecordid><originalsourceid>FETCH-LOGICAL-c368t-5392e702ab78eaddcbbfba9a26343dae8966fd53fcdf8a3b0e1870b59232d1c63</originalsourceid><addsrcrecordid>eNp1kE1PwzAMhiMEYmPwA7igSly4dCRxkqZHNPElDThsnKu0cVGnri3JirR_T6oNkEBcbNl-_Np6CTlndMpYklxTSoGB0JwzGoKWB2TMpJRxqjkckvEwjwdgRE68X4VSKMmOyQgkiNBXYyIX6CpTR7NlVLYuem6btkNnNtUH1tvoyTTmDW206GpsqiJ6bFa9q9CfkqPS1B7P9nlCXu9ul7OHeP5y_zi7mccFKL2JJaQcE8pNnmg01hZ5XuYmNVyBAGtQp0qVVkJZ2FIbyCkyndBcphy4ZYWCCbna6Xaufe_Rb7J15Qusa9Ng2_uMKyFAgRIDevkLXbW9a8J3gUqUpEKmOlBsRxWu9d5hmXWuWhu3zRjNBk-zP56GnYu9cp-v0X5vfJkYgOkO8MGsn7P_K34Cbuh8iA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2676504598</pqid></control><display><type>article</type><title>Serial CT for Nonoperatively Managed Splenic Injuries</title><source>SAGE Complete A-Z List</source><creator>Byerly, Saskya E. ; Jones, Michael D. ; Lenart, Emily K. ; Seger, Catherine P. ; Filiberto, Dina M. ; Lewis, Richard H. ; Kerwin, Andrew J. ; Magnotti, Louis J.</creator><creatorcontrib>Byerly, Saskya E. ; Jones, Michael D. ; Lenart, Emily K. ; Seger, Catherine P. ; Filiberto, Dina M. ; Lewis, Richard H. ; Kerwin, Andrew J. ; Magnotti, Louis J.</creatorcontrib><description>Introduction
The role of serial computed tomography (CT) in the nonoperative management of blunt splenic injuries (NOMSIs) remains unclear. The purpose of the study was to determine the utility of serial CT of Grade 2-5 NOMSI in the modern era.
Methods
Blunt splenic injuries were identified over a 3.5-year period, ending in 6/2020. Our institutional protocol for NOMSI mandates a repeat 24-hour CT for Grade 2-5 injuries. Patients age<18, Grade 1 injuries and patients that underwent intervention prior to repeat scan were excluded. Demographics, comorbidities, timing of events (admission, CTs, splenectomy, and angiography), injury details, procedural details, total transfusion requirements, complications, length of stay, mortality, and discharge disposition were recorded. Descriptive statistics were performed.
Results
219 patients with Grade 2-5 NOMSI had both an initial and 24-hour CT after exclusions. 24-hour CT identified 14 patients with new PSA(s) and 11 (5%) went to angiography within 24 hours with 9 (4%) undergoing angioembolization and 4 (2%) had splenectomy. Two hundred and four (93%) had no intervention though eventually 12 went on to angiography and 6 went for splenectomy. The 24-hour CT rarely altered management in the absence of clinical indication or prior PSA on initial CT with 5 (2%) receiving a therapeutic embolization and 2 (1%) had a nontherapeutic angiogram. No deaths were attributable to splenic injury.
Conclusions
Routine 24-hour CT for NOMSI did not impact management. Clinical status and change in exam may warrant repeat CT in select cases in the setting of a plausible alternate explanation. Prompt angioembolization or splenectomy is more appropriate in clear-cut cases of failed NOMSI.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348221082285</identifier><identifier>PMID: 35341346</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Angiography ; Cardiac arrhythmia ; Complications ; Computed tomography ; Demographics ; Embolization ; Injuries ; Medical imaging ; Patients ; Spleen ; Splenectomy ; Surgery ; Surveillance ; Tomography ; Transfusion ; Trauma ; Trauma centers</subject><ispartof>The American surgeon, 2022-07, Vol.88 (7), p.1504-1509</ispartof><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-5392e702ab78eaddcbbfba9a26343dae8966fd53fcdf8a3b0e1870b59232d1c63</citedby><cites>FETCH-LOGICAL-c368t-5392e702ab78eaddcbbfba9a26343dae8966fd53fcdf8a3b0e1870b59232d1c63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348221082285$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348221082285$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35341346$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Byerly, Saskya E.</creatorcontrib><creatorcontrib>Jones, Michael D.</creatorcontrib><creatorcontrib>Lenart, Emily K.</creatorcontrib><creatorcontrib>Seger, Catherine P.</creatorcontrib><creatorcontrib>Filiberto, Dina M.</creatorcontrib><creatorcontrib>Lewis, Richard H.</creatorcontrib><creatorcontrib>Kerwin, Andrew J.</creatorcontrib><creatorcontrib>Magnotti, Louis J.</creatorcontrib><title>Serial CT for Nonoperatively Managed Splenic Injuries</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Introduction
The role of serial computed tomography (CT) in the nonoperative management of blunt splenic injuries (NOMSIs) remains unclear. The purpose of the study was to determine the utility of serial CT of Grade 2-5 NOMSI in the modern era.
Methods
Blunt splenic injuries were identified over a 3.5-year period, ending in 6/2020. Our institutional protocol for NOMSI mandates a repeat 24-hour CT for Grade 2-5 injuries. Patients age<18, Grade 1 injuries and patients that underwent intervention prior to repeat scan were excluded. Demographics, comorbidities, timing of events (admission, CTs, splenectomy, and angiography), injury details, procedural details, total transfusion requirements, complications, length of stay, mortality, and discharge disposition were recorded. Descriptive statistics were performed.
Results
219 patients with Grade 2-5 NOMSI had both an initial and 24-hour CT after exclusions. 24-hour CT identified 14 patients with new PSA(s) and 11 (5%) went to angiography within 24 hours with 9 (4%) undergoing angioembolization and 4 (2%) had splenectomy. Two hundred and four (93%) had no intervention though eventually 12 went on to angiography and 6 went for splenectomy. The 24-hour CT rarely altered management in the absence of clinical indication or prior PSA on initial CT with 5 (2%) receiving a therapeutic embolization and 2 (1%) had a nontherapeutic angiogram. No deaths were attributable to splenic injury.
Conclusions
Routine 24-hour CT for NOMSI did not impact management. Clinical status and change in exam may warrant repeat CT in select cases in the setting of a plausible alternate explanation. Prompt angioembolization or splenectomy is more appropriate in clear-cut cases of failed NOMSI.</description><subject>Angiography</subject><subject>Cardiac arrhythmia</subject><subject>Complications</subject><subject>Computed tomography</subject><subject>Demographics</subject><subject>Embolization</subject><subject>Injuries</subject><subject>Medical imaging</subject><subject>Patients</subject><subject>Spleen</subject><subject>Splenectomy</subject><subject>Surgery</subject><subject>Surveillance</subject><subject>Tomography</subject><subject>Transfusion</subject><subject>Trauma</subject><subject>Trauma centers</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp1kE1PwzAMhiMEYmPwA7igSly4dCRxkqZHNPElDThsnKu0cVGnri3JirR_T6oNkEBcbNl-_Np6CTlndMpYklxTSoGB0JwzGoKWB2TMpJRxqjkckvEwjwdgRE68X4VSKMmOyQgkiNBXYyIX6CpTR7NlVLYuem6btkNnNtUH1tvoyTTmDW206GpsqiJ6bFa9q9CfkqPS1B7P9nlCXu9ul7OHeP5y_zi7mccFKL2JJaQcE8pNnmg01hZ5XuYmNVyBAGtQp0qVVkJZ2FIbyCkyndBcphy4ZYWCCbna6Xaufe_Rb7J15Qusa9Ng2_uMKyFAgRIDevkLXbW9a8J3gUqUpEKmOlBsRxWu9d5hmXWuWhu3zRjNBk-zP56GnYu9cp-v0X5vfJkYgOkO8MGsn7P_K34Cbuh8iA</recordid><startdate>20220701</startdate><enddate>20220701</enddate><creator>Byerly, Saskya E.</creator><creator>Jones, Michael D.</creator><creator>Lenart, Emily K.</creator><creator>Seger, Catherine P.</creator><creator>Filiberto, Dina M.</creator><creator>Lewis, Richard H.</creator><creator>Kerwin, Andrew J.</creator><creator>Magnotti, Louis J.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20220701</creationdate><title>Serial CT for Nonoperatively Managed Splenic Injuries</title><author>Byerly, Saskya E. ; Jones, Michael D. ; Lenart, Emily K. ; Seger, Catherine P. ; Filiberto, Dina M. ; Lewis, Richard H. ; Kerwin, Andrew J. ; Magnotti, Louis J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-5392e702ab78eaddcbbfba9a26343dae8966fd53fcdf8a3b0e1870b59232d1c63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Angiography</topic><topic>Cardiac arrhythmia</topic><topic>Complications</topic><topic>Computed tomography</topic><topic>Demographics</topic><topic>Embolization</topic><topic>Injuries</topic><topic>Medical imaging</topic><topic>Patients</topic><topic>Spleen</topic><topic>Splenectomy</topic><topic>Surgery</topic><topic>Surveillance</topic><topic>Tomography</topic><topic>Transfusion</topic><topic>Trauma</topic><topic>Trauma centers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Byerly, Saskya E.</creatorcontrib><creatorcontrib>Jones, Michael D.</creatorcontrib><creatorcontrib>Lenart, Emily K.</creatorcontrib><creatorcontrib>Seger, Catherine P.</creatorcontrib><creatorcontrib>Filiberto, Dina M.</creatorcontrib><creatorcontrib>Lewis, Richard H.</creatorcontrib><creatorcontrib>Kerwin, Andrew J.</creatorcontrib><creatorcontrib>Magnotti, Louis J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Byerly, Saskya E.</au><au>Jones, Michael D.</au><au>Lenart, Emily K.</au><au>Seger, Catherine P.</au><au>Filiberto, Dina M.</au><au>Lewis, Richard H.</au><au>Kerwin, Andrew J.</au><au>Magnotti, Louis J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serial CT for Nonoperatively Managed Splenic Injuries</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2022-07-01</date><risdate>2022</risdate><volume>88</volume><issue>7</issue><spage>1504</spage><epage>1509</epage><pages>1504-1509</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Introduction
The role of serial computed tomography (CT) in the nonoperative management of blunt splenic injuries (NOMSIs) remains unclear. The purpose of the study was to determine the utility of serial CT of Grade 2-5 NOMSI in the modern era.
Methods
Blunt splenic injuries were identified over a 3.5-year period, ending in 6/2020. Our institutional protocol for NOMSI mandates a repeat 24-hour CT for Grade 2-5 injuries. Patients age<18, Grade 1 injuries and patients that underwent intervention prior to repeat scan were excluded. Demographics, comorbidities, timing of events (admission, CTs, splenectomy, and angiography), injury details, procedural details, total transfusion requirements, complications, length of stay, mortality, and discharge disposition were recorded. Descriptive statistics were performed.
Results
219 patients with Grade 2-5 NOMSI had both an initial and 24-hour CT after exclusions. 24-hour CT identified 14 patients with new PSA(s) and 11 (5%) went to angiography within 24 hours with 9 (4%) undergoing angioembolization and 4 (2%) had splenectomy. Two hundred and four (93%) had no intervention though eventually 12 went on to angiography and 6 went for splenectomy. The 24-hour CT rarely altered management in the absence of clinical indication or prior PSA on initial CT with 5 (2%) receiving a therapeutic embolization and 2 (1%) had a nontherapeutic angiogram. No deaths were attributable to splenic injury.
Conclusions
Routine 24-hour CT for NOMSI did not impact management. Clinical status and change in exam may warrant repeat CT in select cases in the setting of a plausible alternate explanation. Prompt angioembolization or splenectomy is more appropriate in clear-cut cases of failed NOMSI.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>35341346</pmid><doi>10.1177/00031348221082285</doi><tpages>6</tpages></addata></record> |
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| subjects | Angiography Cardiac arrhythmia Complications Computed tomography Demographics Embolization Injuries Medical imaging Patients Spleen Splenectomy Surgery Surveillance Tomography Transfusion Trauma Trauma centers |
| title | Serial CT for Nonoperatively Managed Splenic Injuries |
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