Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature.

Abstract

Using CT to grade blunt splenic injuries frequently does not predict clinical outcome. This retrospective, blinded study evaluated whether revealing a traumatic pseudoaneurysm or frank hemorrhage on an initial CT examination can be used to predict the successful clinical outcome of patients managed without surgery. The medical and CT records of all patients with blunt splenic injury during a 5-year period were independently reviewed for vascular abnormalities. Also, the grade of injury was reconfirmed. Hemodynamically stable patients with injuries of grades 1-3 were managed without surgery. Clinical failure occurred if a patient required splenectomy or splenorrhaphy after any attempt of nonsurgical management. Two hundred sixty-three patients were treated for blunt splenic injuries. Eighty-two of these patients underwent emergent surgery on the basis of clinical and peritoneal lavage findings without CT examination. The remaining 181 (69%) patients were initially evaluated with emergent abdominal CT. Of these 181 patients, 72 (40% of those undergoing CT) were treated nonsurgically. Nonsurgical therapy failed in 11 (15%) of these 72 patients. Of these 11 patients, nine (82%) had a defined vascular abnormality of the spleen. Only eight (13%) of the remaining 61 patients who underwent CT and successful nonsurgical management had a vascular abnormality of the spleen. The failure rate in patients with nonsurgically managed blunt splenic injuries may be markedly reduced if patients with traumatic pseudoaneurysm or active hemorrhage revealed on emergent CT are treated with early surgical or endovascular repair.