A more targeted embolization strategy in blunt splenic trauma reduces procedural volume without increasing splenectomy rates.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE

Journal of Trauma and Acute Care Surgery Pub Date : 2025-07-17 DOI:10.1097/TA.0000000000004710

Amanda M Marsh, Navpreet K Dhillon, Rosemary A Kozar, Joseph J DuBose, C Yvonne Chung, Rishi Kundi, Thomas M Scalea, Melike N Harfouche

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引用次数: 0

Abstract

Background: The role of splenic angioembolization (SAE) in blunt splenic injury (BSI) has evolved. Revision of the American Association for the Surgery of Trauma (AAST) Splenic Organ Injury Scale BSI classification scheme and increased quality of computed tomography (CT) scans may now identify injuries that no longer benefit from SAE. Our current BSI algorithm recommends mandatory SAE only for high-risk features (pseudoaneurysms ≥10 mm, moderate to large hemoperitoneum, significant parenchymal injury). We hypothesized that this strategy reduced the use of SAE without increasing overall splenectomy or delayed splenectomy rates.

Methods: We reviewed hemodynamically stable patients with AAST Grades II to V BSI on initial contrast CT scan. Patients who underwent splenectomy prior to CT were excluded. An interrupted time-series analysis was performed with a cutoff of January 2019, when the algorithm was introduced, spanning 3 years before and 5.5 years after (PRE vs. POST). The primary outcomes of interest were changes in rates of SAE, overall splenectomy, and delayed splenectomy >24 hours after admission across the two time periods.

Results: A total of 840 patients met the inclusion criteria, 369 individuals in the PRE group versus 471 in the POST group. The overall rate of SAE decreased from 29% to 17% (p < 0.001) after algorithm implementation without a significant change in rates of overall splenectomy (PRE 30% vs. POST 34%, p = 0.14) or delayed splenectomy (PRE 1.9% vs. POST 3.6%, p = 0.014). In the absence of any significant changes in AAST grade or rates of pseudoaneurysm in the PRE and POST periods, fitted time trends for monthly rates of SAE demonstrate a sharp decline after introduction of the algorithm (p = 0.04).

Conclusion: A more selective approach to the use of angioembolization for BSI leads to a reduction in procedural volumes without increasing overall or delayed splenectomy rates. Future research should evaluate conservative approaches of SAE while better defining which high-risk features are mitigated by SAE.

Level of evidence: Therapeutic/Care Management; Level IV.

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在钝性脾创伤中更有针对性的栓塞策略可以减少手术体积而不增加脾切除术率。

背景：脾血管栓塞术（SAE）在钝性脾损伤（BSI）中的作用不断发展。美国创伤外科协会（AAST）脾器官损伤分级表BSI分类方案的修订和计算机断层扫描（CT）扫描质量的提高，现在可以识别不再受益于SAE的损伤。我们目前的BSI算法建议仅对高风险特征（假性动脉瘤≥10mm，中大腹膜出血，明显的实质损伤）强制SAE。我们假设该策略减少了SAE的使用，而不会增加整体脾切除术或延迟脾切除术的发生率。方法：我们回顾了血流动力学稳定的AAST II级至V级BSI患者的初始CT造影扫描。排除CT前行脾切除术的患者。在引入该算法时，以2019年1月为截止日期进行了中断时间序列分析，涵盖了前3年和后5.5年（PRE与POST）。研究的主要结局是入院后24小时内SAE、全脾切除术和延迟脾切除术发生率的变化。结果：共有840例患者符合纳入标准，PRE组369例，POST组471例。算法实施后，SAE的总发生率从29%下降到17% (p < 0.001)，而整体脾切除术（PRE 30% vs POST 34%, p = 0.14）或延迟脾切除术（PRE 1.9% vs POST 3.6%, p = 0.014）的发生率没有显著变化。在术前和术后AAST分级或假性动脉瘤发生率没有明显变化的情况下，引入该算法后，每月SAE发生率的拟合时间趋势显示急剧下降（p = 0.04）。结论：血管栓塞治疗BSI更有选择性的方法可以减少手术体积，而不会增加整体或延迟脾切除术的发生率。未来的研究应该评估SAE的保守方法，同时更好地定义SAE减轻了哪些高风险特征。证据水平：治疗/护理管理；IV级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.