Abstract
BackgroundRecent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Nevertheless, such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach.MethodsA questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES). This was delivered and answered live by acute care surgeons attending the 6th WSES congress in Nijmegen in 2019. A dedicated mobile phone application was utilized to collect the answers. All answers were evaluated for areas of discrepancy with an 80% threshold for consensus between respondents.ResultsThree factors generated discrepancy in opinion for managing this pattern of injury: the patients’ injury severity, the presence of a bleeding diathesis, and an associated intra-abdominal injury. Agreement was obtained for the other eight factors.ConclusionResearchers should focus their efforts on the identified area of discrepancy. Clinicians should use additional care in the presence of the three factors for which discordant opinions were found.
Highlights
Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury
We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach
A questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES)
Summary
Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. The American Association for the Surgery of Trauma (AAST) grading ( referred upon as grade) and the presence of contrast extravasation on computed tomography (CT) ( referred upon as blush) play an important role in planning the management of splenic injuries. A high rate of practice variation hinders management of grade III splenic lesions [10] This can be confounded by factors like patient age, associated injury, presence of haemoperitoneum, co-morbidities and overall injury severity [11]
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