1Ali Barah, 1Ayman Elmagdoub, 1Loai Aker, 1Zeyad Jaleel, 1Zahoor Ahmed, 1Ammar Al-Hassani, 1Ahmed Omar
1Hamad Medical Corporation, Doha, Qatar
1- To demonstrate the institutional experience in the management of patients with splenic injuries due to blunt trauma in a level I trauma center.
2- To evaluate the predictive value of CT severity index system (CTSI) in terms of patient’s outcome and correlation with the failure of non-operative management.
3- To identify potential limitations in the CTSI system in guiding the clinical management.
Material(s) and Method(s):
A retrospective cohort analysis was conducted over a 7-year period (Jan 2013-Dec 2019) using the institution’s radiologic studies registry.
Inclusion criteria included admitted adult patients who suffered blunt splenic trauma, and underwent a proper abdominal CT scan at admission.
For each patient, the following data was retrospectively assessed: gender, age, mechanism of injury, CTSI score, intensive care unit length of stay, initial non-operative (NOM) or operative management (OM), failure of NOM, and in-hospital mortality with cause of death, and the development of delayed splenic vascular injury (DSVI). Descriptive features, Mann-Whitney U test and independent t-test were used to analyze and compare the patients groups.
Among the study population (83 patients), 14 patients were excluded due to insufficient data, improper imaging protocol. 11/69 patients (16%) required surgical intervention upon admission, 5/69 (7%) failed conservative management and needed secondary surgical splenectomy. 53/69 patients (77%) had successful NOM, with 22/53 needing splenic angioembolization. Seven patients (7/22) had their angioembolization procedures for DVSI.
Patients with higher CSTI, and hemoperitoneum score in CT at admission were more likely to need primary or secondary OM than those with lower CSTI grading or hemoperioneum score (p value= 0.002 and 0.01, respectively). However, there was no statistical significance regarding the CTSI score or hemiporitoneum grade in CT with the probability of needing secondary OM after NOM.
Patients presenting with splenic injuries after blunt trauma with higher CTSI and hemoperitoneum score at admission CT scan are more likely to need OM. We suggest further revisions of the available scoring systems to consider other clinical and radiologic parameters in deciding the appropriate management plan.