Sohaib Ahmed (Târgu Mureș / RO), Ovidiu Budisca (Târgu Mureș / RO), Valentin Strugari (Târgu Mureș / RO), Ahsan Mushtaq (Târgu Mureș / RO), Mihai Bălan (Târgu Mureș / RO), Izabella Varga (Târgu Mureș / RO), Ludovic-Alexandru Szanto (Târgu Mureș / RO), Daria Matache (Târgu Mureș / RO), Vladimir Bacarea (Târgu Mureș / RO), Ioana Halmaciu (Târgu Mureș / RO), Călin Molnar (Târgu Mureș / RO)
Abstract text (incl. references and figure legends)
Background: In recent years there has been an increasing focus towards non-operative management (NOM) of abdominal trauma. A modified CT severity Index (CTSI) for spleen and liver injury (AAST) has been proposed as a better diagnostic and mortality predictor for hepatic and splenic trauma, acting as a guide towards better decision-making in therapeutic management of hepato-splenic injuries.
Aim: To evaluate the modified CT severity index in its accuracy of diagnosis and predictive prognosis in hepatic and splenic injuries, when considering a NOM vs OM approach.
Materials and methods: A 5-year retrospective, observational study comprising of 117 admissions was conducted in patients presenting at the 1st Department Of Surgery, Clinical Emergency Hospital Targu Mures, Romania with abdominal trauma, between January 2017 and December 2021. CT results were systematically evaluated and graded based on the modified CTSI criteria for spleen and liver injury (AAST).
Results: Of the total 117 cases resulting in admissions due to abdominal trauma, 71 cases were included in the study, 18(25%) were placed in hepatic Injury category, 42(59%) in splenic injury category and 11(15%) in hepatosplenic injury category. NOM was applied to 10(14%) of the cases, all with injuries below grade III, resulting in favorable prognosis and no mortality. A total of 12(17%) deaths were observed, out of which 1(8%) was in hepatic injury category, 7(58%) in splenic injury category and 4(33%) were in hepatosplenic injury category, with all grade IVA or higher injury grade. CT imaging based on the CTSI criteria for spleen and liver injury (AAST) showed a higher diagnostic accuracy and prediction of mortality in splenic injury category 90% vs. 83% in hepatic injury vs. 81% in hepatosplenic injury.
Conclusions: CTSI (AAST) remains to be an important if not the main factor in determining NOM vs OM in hepatic and splenic injury.
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