Ismail Mahmood (Doha / QA), Basil Younis (Doha / QA), Mohammad Abdallat (Doha / QA), Saji Mathradikkal (Doha / QA), Ayman El-Menyar (Doha / QA), Ammar Al-Hassani (Doha / QA), Ruben Peralta (Doha / QA), Hassan Al-Thani (Doha / QA), Mohammad Asim (Doha / QA), Sandro Rizoli (Doha / QA), Mohammad Kasim (Doha / QA)
Abstract text (incl. references and figure legends)
Introduction:
High-grade blunt splenic trauma presents clinical challenges and our aim is to assess the utility of non-operative management following a treatment guideline.
Material and Methods: We developed a guideline requiring splenic angiography and embolization for all hemodynamically stable patients with high-grade splenic injuries. The data over a nine-year- period ending in 2019 were retrospectively reviewed.
Results:
A total of five hundred and fifty-two hemodynamically stable adult patients with blunt splenic injury underwent nonoperative management. Eighty-one patients with grade III to V injuries were admitted in the pre-implementation period and one hundred and fifty-nine with similar injuries were admitted in the post-implementation period.
The non-operative management rates increased from 50.6% to 68.6% and operative management decreased from 49.4% to 31 .6% (p =0.001). in addition, the requirement for blood transfusion dropped from 64.2% to 45.9% (p =0.007) in the post-implementation period. Overall mortality was similar between the two periods. However, hospital and ICU length of stay, and ventilatory days were higher in the post-guideline implementation group.
Conclusions:
Our study shows that using a treatment guideline for high-grade splenic injuries could increase the success rate for nonoperative rate and limit unnecessary laparotomy. However, this approach was associated with prolonged hospitalization.
References:
1. Clements, W.; Joseph, T.; Koukounaras, J.; Goh, G. S.; Moriarty, H. K.; Mathew, T. D., Splenic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study. CVIR endovascular 2020, 3, (1), 92.
2. Zarzaur, B. L.; Rozycki, G. S., An update on nonoperative management of the spleen in adults. Trauma surgery & acute care open 2017, 2, (1), e000075.
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