Abstract text (incl. references and figure legends)
Introduction: The AAST scale is widely used in grading splenic trauma, which are either managed conservatively, by splenic artery embolization (SAE), or operatively with spleen-preserving surgery (SPS) or splenectomy. How does the AAST grade influence decision making in management of splenic trauma?
Materials & Methods: A retrospective analysis was conducted of the prospective database of splenic trauma from a UK Major Trauma Centre between September 2015 and June 2022 (n= 211).
Results: Of 211 patients, 14.7% had grade (G) 1, 31.8% G2, 21.3% G3, 15.6% G4 and 15.6% G5 splenic injuries. 88.6% had other coexisting injuries, primarily skeletal trauma (70%). Isolated splenic trauma were mainly G4 or G5 (52.5%), underwent splenectomy (43.5%) and had mortality of 4.4%, average length of stay (LOS) 7.5 days, and 30-day mortality/morbidity rate of 26%.[NO1] G1 and G2 injuries were mainly managed conservatively (71%,76%), and G4 and G5"s mainly underwent splenectomy (48.5%,84.9%). SAE was most common in G4 injuries (30%), followed by G3 and G5 (15.6%,9.1%). Failure of conservative management was highest in G3 injuries with 8.7% progressing to splenectomy. No G3 SAE"s required splenectomy. 10% of G4"s and 66.7% of G5 SAE"s [NO2] progressed to splenectomy. Overall, splenectomy patients had similar length of stay compared to SAE cohort (13.6 days vs 14.9 days), higher critical care admission (79.6% vs 33.3%) and 30-day mortality/morbidity (50.9% vs 45.8%) rates. No SPS managed injuries progressed to splenectomy. 54.6% of SPS were in G1 injuries, yet 63.6% required critical care, mortality rate was 9% and this cohort had the longest LOS at 17.6 days.
Conclusion: Isolated high grade splenic injuries are uncommon but have good outcomes. G3 splenic injuries show good outcomes with SAE, however G4 and G5"s were more likely to require operative management. SPS had outcomes disproportionate to grade of injuries which were attributable to coexisting injuries.
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