Nonoperative management of blunt splenic injury: Need for routine serial imaging? A ten-year retrospective series.

Background: The role for routine follow-up imaging in nonoperative management (NOM) of blunt splenic injury (BSI) remains controversial. Delayed complications, specifically vascular abnormalities such as pseudoaneurysms are associated with failure of NOM (FNOM). This study examined a ten-year experience with NOM of BSI and the influence of repeat imaging. Our centers have no guidelines for follow-up imaging.

Methods: A retrospective cohort study was conducted including all trauma patients with BSI admitted within a regional trauma system (two Level III and one Level I ACS-verified trauma centers) between 2013 and 2022. Patient demographics, injury features, imaging and outcomes were obtained from trauma registry data and chart review. Patients undergoing splenectomy 6 hours or more after presentation were categorized as FNOM.

Results: A total of 1815 patients presented with BSI during the study period. Urgent splenectomy was performed in 15.6 % (N=283). The rate of FNOM was 3.4 % (N=62). Among the 1532 patients initially managed nonoperatively, 139 (9.1 %) underwent a follow-up CT scan. Most scans were obtained in response to clinical changes, while 13.7 % (N= 19) were obtained for splenic surveillance. Follow-up scans were followed by 8 splenectomies and 9 embolizations. Among the 19 scans performed for surveillance, two revealed a pseudoaneurysm; one of which underwent embolization. Results are limited by a low rate of screening imaging and a lack of long-term outcome information.

Conclusion: A low rate of FNOM was achieved despite less than 2 % (19/1532) of patients undergoing screening follow-up imaging. These findings suggest that there is limited opportunity for routine surveillance imaging to improve outcomes in BSI. Reimaging in response to clinical changes is a cost-effective alternative.