4:12 PM Abstract No. 372 The role of interventional radiology in the contemporary management of splenic trauma: a national trauma data bank study

Abstract

To compare utilization and outcomes of splenic artery embolization (SAE) with surgical management or non-operative management (NOM) in patients with blunt splenic trauma. The National Trauma Data Bank was queried for patients who sustained blunt splenic trauma between 2007 and 2015. Patients dead upon arrival and those with an Abbreviated Injury Scale (AIS) grade 4 or 5 traumatic brain or spinal injury, any grade aortic injury, or additional grade 4 or 5 abdominopelvic injury were excluded. Patients were then categorized by treatment group: NOM (defined as close monitoring without surgical or interventional management), SAE, splenectomy, and splenic repair. Outcomes evaluated included hospital length of stay (LOS) days, ICU LOS days, failure of nonoperative management, and mortality. Tukey’s tests were used for pairwise comparisons of different treatment modalities. Between 2007 and 2015, the annual documented cases of splenic trauma increased from 9123 to 15,775. Overall, 85,793 (73.8%) had NOM, 21,999 (18.6%) had splenectomy, 3895 (3.3%) underwent SAE, and 2131 (1.8%) had splenic repair. Mortality rates decreased from 8.2% in 2007 to 4.9% in 2015. The utilization rate of NOM did not significantly change (74% in 2008 and 73% in 2015). Surgical management decreased by 4.5% and SAE increased by 3.5%. Failure of NOM decreased from 4.2% in 2007 to 1.5% in 2015. Combining injury grades, NOM had the shortest LOS days (8.3) vs. 12.6 for SAE vs. 13.8 for splenectomy vs. 12.3 for splenic repair (P <0.001). Similarly, the ICU LOS days was shortest for NOM (5.5), SAE (8.1), splenectomy (8.6), splenic repair (6.5) (P <0.001). For mortality across all injury grades, splenectomy (11.0%) was significantly higher than splenic repair (3.8%), SAE (4.9%), and NOM (3.7%) with P <0.001. In contemporary clinical practice, NOM remains the most common treatment choice for managing splenic trauma irrespective of injury grade. SAE rates are increasing while surgery is decreasing. Compared to splenectomy, SAE demonstrated shorter hospital and ICU LOS and decreased mortality.Tabled 1Summary of Outcomes of Various Treatment OptionsMean LOS (SD)ICU Days (SD)Mortality Rate (%)NOM8.3 (10.6)5.5 (7.6)3053 (3.7)SAE13.8 (15.0)8.6 (10.9)2503 (11.0)Splenectomy12.3 (12.9)7.4 (10.0)81 (3.8)Splenic repair12.5 (14.3)8.1 (10.8)185 (4.9) Open table in a new tab