Splenic embolisation practices within the UK: a national survey

Abstract

•There is wide variability in the selection and technique of splenic embolisation. •There is a lack of clear evidence and guidelines on the use of splenic embolisation. •Urgent investment in the provision of 24/7 IR services is still required. AIM To review UK splenic embolisation (SE) practices for traumatic injury. MATERIALS AND METHODS An online survey approved by the British Society of Interventional Radiology (BSIR) Audit and Registry Committee was distributed to BSIR members between 15/11/2021–29/11/2021. Data obtained included the interventional radiology (IR) trauma service response, service design, institutional treatment pathways, and key clinical decision-making factors. Descriptive statistics were carried using Microsoft Excel. RESULTS A total of 62 responses, of which 61.29% (n=38) worked at a major trauma centre (MTC); 70.97% (n=44) had an interventional radiologist on-call 24/7; 77.42% (n=48) had no direct involvement with the trauma team until an eligible case was identified with only 19.35% (n=12) being part of the acute receiving trauma team; 88.71% (n=55) did not have a standard imaging pathway for conservatively managed splenic injury in their institution. In terms of the proportion of respondents considering embolisation based on severity of splenic injury, 51% (n=32) would embolise grade 5 injuries, 66% (n=41) for grade 4, 54% (n=34) for grade 3, and 12.9% (n=8) for grade 2. CONCLUSION Wide variability exists in the SE practice and decision-making within the UK IR community. A UK consensus on management of traumatic splenic injuries is required; however, an improved evidence base is essential to support these guidelines. To review UK splenic embolisation (SE) practices for traumatic injury. An online survey approved by the British Society of Interventional Radiology (BSIR) Audit and Registry Committee was distributed to BSIR members between 15/11/2021–29/11/2021. Data obtained included the interventional radiology (IR) trauma service response, service design, institutional treatment pathways, and key clinical decision-making factors. Descriptive statistics were carried using Microsoft Excel. A total of 62 responses, of which 61.29% (n=38) worked at a major trauma centre (MTC); 70.97% (n=44) had an interventional radiologist on-call 24/7; 77.42% (n=48) had no direct involvement with the trauma team until an eligible case was identified with only 19.35% (n=12) being part of the acute receiving trauma team; 88.71% (n=55) did not have a standard imaging pathway for conservatively managed splenic injury in their institution. In terms of the proportion of respondents considering embolisation based on severity of splenic injury, 51% (n=32) would embolise grade 5 injuries, 66% (n=41) for grade 4, 54% (n=34) for grade 3, and 12.9% (n=8) for grade 2. Wide variability exists in the SE practice and decision-making within the UK IR community. A UK consensus on management of traumatic splenic injuries is required; however, an improved evidence base is essential to support these guidelines.