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

Abstract

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.

A Pseudo-Dilemma: Are We Over-Diagnosing and Over-Treating Traumatic Splenic Intraparenchymal Pseudoaneurysms?

“…A separate study by Wallen et al 23 demonstrated that 67% of splenic PSAs were detected in delayed fashion. These studies and others have provided evidence to support routine surveillance imaging for high-grade splenic injury 24 …”

“…These studies and others have provided evidence to support routine surveillance imaging for high-grade splenic injury. 24 As frequent CT imaging for BSI has proliferated, clinicians began identifying even smaller, more occult vascular injuries, raising the question of whether we should modify our approach. The group at Wake Forest has shown that mandatory embolization of Grade IV injuries regardless of whether a PSA is seen on CT greatly improves outcome of NOM.…”