A nationwide Australian cross-sectional study assessing current management and infection prevention practices after Splenic Artery Embolisation (SAE) following trauma.

Abstract

Introduction: Management of patients after blunt splenic injury treated with Splenic Artery Embolisation (SAE) varies. This includes vaccination, post-procedure antibiotic use, and follow-up. This study aimed to assess current practice of management and infection prevention across Australia.

Methods: A 29-question survey was sent via the Australian and New Zealand Trauma Registry to all 28 contributing trauma hospitals in Australia. Questions were based on data from the 2022 calendar year.

Results: Responses were received from 12 sites (43 %) including 6 of 8 Australian regions (75 %). Of responding sites, 10 (83 %) offer SAE via a 24-hour 7-day rostered service. Of a total 568 splenic injuries, there were 177 SAE treatments with a median of 8 per site (range 0-65). SAE constituted 31 % of all splenic management, conservative management in 65 %, and splenectomy in 4 %. 8 sites (67 %) had a protocol for splenic trauma. Prophylactic SAE was performed for AAST IV-V injuries at 8 sites (67 %), which included 80 % of adult hospitals. Distal SAE was the predominant treatment type (70 %). Patients were routinely admitted for median 4 days after SAE (range 2-5). Routine inpatient antibiotics were administered to SAE patients at 2 sites (17 %) while 1 site (8 %) routinely recommended lifelong antibiotics after SAE. Routine inpatient vaccinations were used by 4 of 11 sites (36 %), while 3 sites (25 %) recommend vaccinations in the future. 11 sites (92 %) follow-up patients post-discharge. Written information on SAE was given to patients at 9 hospitals (75 %) while splenic function testing was performed at 5 sites (42 %), mostly assessment for Howell-Jolly Bodies (80 %). 11 sites (92 %) would change clinical practice in the future if evidence on splenic immune function evolved.

Conclusion: Across responding Australian hospitals, the use of vaccinations, antibiotics, and splenic function testing after SAE was low, which reflects existing evidence for preserved splenic function after SAE, plus unpublished experience of key stakeholders. Key societies should consider clinical practice guidelines that merge existing evidence with modern practice.