Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

Podda, Mauro; Simone, Belinda De; Ceresoli, Marco; Virdis, Francesco; Favi, Francesco; Larsen, Johannes Wiik; Coccolini, Federico; Sartelli, Massimo; Παραράς, Νικόλαος; Beka, Solomon Gurmu; Bonavina, Luigi; Bova, Raffaele; Pisanu, Adolfo; Abu‐Zidan, Fikri M.; Balogh, Zsolt J.; Chiara, Osvaldo; Wani, Imtiaz; Stahel, Philip F.; Saverio, Salomone Di; Scalea, Thomas M.; Søreide, Kjetil; Sakakushev, Boris; Amico, Francesco; Martino, Costanza; Hecker, Andreas; de’Angelis, Nicola; Chirica, Mircea; Galante, Joseph M.; Kirkpatrick, Andrew W.; Pikoulis, Emmanouil; Kluger, Yoram; Bensard, Denis D.; Ansaloni, Luca; Fraga, Gustavo Pereira; Civil, Ian; Tebala, Giovanni Domenico; Carlo, Isidoro Di; Y, Cui; Coimbra, Raúl; Agnoletti, Vanni; Sall, Ibrahima; Tan, Edward; Picetti, Edoardo; Litvin, Andrey; Damaskos, Dimitrios; Inaba, Kenji; Leung, JT; Maier, Ronald V.; Biffl, Walt; Leppäniemi, Ari; Moore, Ernest E.; Gurusamy, Kurinchi Selvan; Catena, Fausto

doi:10.1186/s13017-022-00457-5

Cited by 34 publications

(25 citation statements)

References 169 publications

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“…The WSES consensus guideline suggests that "follow-up imaging with contrast-enhanced ultrasound/ CT scan in 48-72 hours post-admission of trauma in splenic injuries AAST Grade III or higher treated with non-operative management [is] considered the best strategy for timely detection of vascular complications." 3 The 2022 WSES guidelines are similar to this study's guidelines in that they recommend repeat imaging with contrast-enhanced ultrasound or CT scan in 48-72 hours after admission. In this study, the median time to the initial repeat CT scan was 2 days from admission.…”

mentioning

confidence: 72%

“…The 2022 WSES guidelines suggest "radiological follow-up to be based on clinical findings in AAST grade I-II splenic trauma treated with nonoperative management and suggests against routine imaging followup in these patients." 3 The experience of the level I trauma center in this study was to re-image grade II injuries based on their institution algorithm. Some of these radiological follow-up scans led to splenic embolization in patients with grade II injuries.…”

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confidence: 99%

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Surveillance Imaging Associated With Delayed Splenectomy in High-Grade Blunt Splenic Trauma

Hawley

Dhillon

DuBose

et al. 2023

The American Surgeon™

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This retrospective, single-site study at a level I trauma center (2016-2021) sought to determine whether repeat CT had an impact on clinical decision making after splenic angioembolization following blunt splenic trauma (grades II-V). The primary outcome was need for intervention after subsequent imaging (defined as angioembolization and/or splenectomy) by high- or low-grade injury. Of the 400 individuals examined, 78 (19.5%) underwent intervention after repeat CT, from which 17% were in the low-grade group (grades II and III) and 22% were in the high-grade group (grades IV and V). Individuals in the high-grade group were 3.6 times more likely to undergo delayed splenectomy than those in the low-grade group ( P = .006). Delayed intervention after surveillance imaging in blunt splenic injury is driven mostly by the identification of new vascular lesions and leads to greater rates of splenectomy in high-grade injuries. Surveillance imaging should be considered for all AAST injury grades II or higher.

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confidence: 72%

mentioning

confidence: 99%

Surveillance Imaging Associated With Delayed Splenectomy in High-Grade Blunt Splenic Trauma

Hawley

Dhillon

DuBose

et al. 2023

The American Surgeon™

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“…A panel of experts, in collaboration with the World Society of Emergency Surgery, recently published a consensus on follow-up strategies for patients with splenic trauma managed non-operatively ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Detection of post-traumatic abdominal pseudoaneurysms by CEUS and CT: A prospective comparative global study (the PseAn study)—study protocol

Virdis

Cioffi²,

Abu‐Zidan³

et al. 2023

Front. Surg.

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The success of non-operative management in trauma increased with the availability of new-generation CT scan machines, endoscopy, and angiography, becoming the standard of care in hemodynamically stable trauma patients with abdominal solid organ injuries, with a success rate of 78% to 98%. Post-traumatic pseudoaneurysms (PAs) can develop at any region of an injured artery and they may cause delayed bleeding in splenic or hepatic trauma, with an incidence in patients treated with NOM of 2%–27% and 1.2%–6.1% respectively. Diagnosis is made by angiography, contrast-enhanced computer tomography (CT), or Doppler Ultrasound (US) while the use of contrast-enhanced ultrasound (CEUS), has increased in recent years although few data are available about CEUS feasibility in the follow-up setting. The PseaAn study has been designed to assess the role of CEUS in the follow-up of abdominal trauma by defining its sensitivity, specificity and predictive values compared with abdominal CT scan. The PseAn study is a multi-centric international diagnostic cross-sectional study initiated by the Level I Trauma Center of the Niguarda Ca’ Granda Hospital in Milan, Italy. To study the role of CEUS in detecting post-traumatic splenic, hepatic, and renal PAs compared with the gold standard of CT with intravenous contrast at different follow-up time points, and whether it can replace CT scan in the follow-up of solid organ injuries, patients with OIS III and above will undergo a follow-up with both a CEUS and CT scan to detect post-traumatic parenchymal pseudoaneurysm within two to five days from injury. The use of CEUS in the follow-up of abdominal trauma follow-up (particularly blunt trauma) has increased, to minimise the use of ionizing radiation and contrast media and encouraging results have been published during the last decade showing that CEUS is an accurate technique for evaluating traumatic lesions of solid abdominal organs. Conclusions We think that CEUS, which is underused worldwide, is a useful and safe tool that may replace CT scan in follow-up with the major advantage of reduced radiation. Our current study may give stronger evidence to support this view.

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“…Regarding the spleen, an imaging follow-up is particularly suggested in injuries for WSES Classes II–III, AAST Grades III–V, in the first 48–72 h, to exclude the development of vascular complications ( Figure 2 and Figure 4 ) [ 6 , 26 ].…”

Section: Computed Tomography (Ct)mentioning

confidence: 99%

“…Due to its properties, and considering its limits, US-CEUS may be adopted in the follow-up of patients who underwent blunt abdominal trauma, particularly in cooperating patients with an adequate body habitus, without extensive cutaneous medications in the area of the examination, and in which it is requested to particularly re-evaluate a specific organ injury ( Figure 4 , Figure 6 , Figure 8 , Figure 9 and Figure 10 ) [ 8 , 26 , 40 ].…”

Section: Ultrasound (Us)mentioning

confidence: 99%

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

et al. 2023

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In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

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Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

Cited by 34 publications

References 169 publications

Surveillance Imaging Associated With Delayed Splenectomy in High-Grade Blunt Splenic Trauma

Surveillance Imaging Associated With Delayed Splenectomy in High-Grade Blunt Splenic Trauma

Detection of post-traumatic abdominal pseudoaneurysms by CEUS and CT: A prospective comparative global study (the PseAn study)—study protocol

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

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