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Western Trauma Association
Management of Adult Blunt Splenic Trauma
Annotation
for Point G
As CT scanning technology has improved, more blushes are
being seen and these may be helpful in predicting
failure of NOM. A modified Splenic Injury Scale that
incorporates vascular blush information into the
anatomic descriptions used in the American Association
for the Surgery of Trauma scoring system has been
developed but needs validation.41At
this point in time, if vascular blush is seen on the
initial CT scan and the patient is hemodynamically
stable, screening angiography may be used as an adjunct
to NOM based on local consensus. In patients with grade
3-4 hemodynamic instability, triage to the OR is prudent
unless intervention radiology is immediately available.
Patients with grade 5 instability should be taken
directly to the OR. If a blush is seen on a delayed
follow-up CT scan, screening angiography is recommended
in the hemodynamically stable patient. There is
considerable variability in the use of angiography
across centers (Table
1). Although more aggressive use of angiography is
associated with the highest rates of NOM (>80%) and the
lowest rates of failure (2-5%), there is ongoing debate
over the optimal use of this intervention because it is
labor intensive and there have been several reports that
document a surprisingly high rate of complications.27,28
In our WTA multi-institutional experience, we reported
on 140 patients who underwent AE, of which 27 (20%)
suffered major complications including 16 (11%) failure
to control bleeding (requiring 9 splenectomies and 7
repeat AE), 4 (3%) missed injuries, 6 (4%) splenic
abscesses, and 1 iatrogenic vascular injury.
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