Trauma center angiography use in high-grade blunt splenic injuries: Timing is everything.

Abstract

The use of angiography (ANGIO) in the management of high-grade (Abbreviated Injury Scale [AIS] score > 2) blunt splenic injury (BSI) remains controversial. We aimed to compare patient characteristics of those treated at high and low ANGIO centers, to compare the characteristics of the patients undergoing ANGIO at high and low ANGIO centers, and to determine the relationship among hospital ANGIO use, the timing of angiography, and splenectomy after angiography. The National Trauma Data Bank was used to identify patients 18 years and older with BSI (AIS score > 2) treated at Level I or II trauma centers that admitted at least 10 patients with high-grade BSI from 2007 to 2010. Timing of ANGIO and splenectomy was determined. Hospitals were stratified based on ANGIO use rates into three groups: 0% (no ANGIO); 1% to 19.9% (low ANGIO); and more than 20% (high ANGIO). Hierarchical logistic regression was used to control for patient clustering at the hospital level and to determine factors associated with splenectomy. Cox regression with ANGIO as a time-varying covariate was also used. A total of 10,405 met inclusion criteria. After adjusting for hospital case mix, low ANGIO (odds ratio, 1.02; 95% confidence interval [CI], 0.70-1.48) and no ANGIO (odds ratio, 0.88; 95% CI, 0.59-1.31) centers showed no difference with regard to splenectomy compared with high ANGIO centers. ANGIO (Hazard Ratio = 0.52; 95% CI, 0.41-0.65) was protective of splenectomy on Cox regression analysis, taking into account ANGIO timing relative to splenectomy. There were no differences in splenectomy rates after adjusting for case mix at high and low ANGIO centers. Early ANGIO, irrespective of hospital ANGIO use, is associated with splenic salvage. Therapeutic study, level III.