Intervention for Splenic Trauma: An International Consensus Survey
Victoria Pegna, Alan Askari, Sebastian Chong, Alex Bull, Lauren Kennedy, Shameen Jaunoo, Mansoor Khan
American Association for the Surgery of Trauma grade, Spleen, Trauma
Citation Information :
Pegna V, Askari A, Chong S, Bull A, Kennedy L, Jaunoo S, Khan M. Intervention for Splenic Trauma: An International Consensus Survey. Panam J Trauma Crit Care Emerg Surg 2023; 12 (1):9-15.
Background: Splenic injury is common in trauma to the abdomen and the management strategies can be varied depending on a variety of clinical and radiological factors. The main aim of this study is to establish consensus on the management of differing grades of splenic trauma and determine which factors influence subsequent choices of operative management (OM), splenic artery embolization (SAE), and non-OM (NOM).
Methods: An electronic survey distributed to trauma surgeons and radiologists from across the globe via existing trauma networks and social media surgical groups. The consensus agreement was defined as a 75% agreement.
Results: In total, 101 trauma surgeons and interventional radiologists responded to the survey. The consensus was obtained for patients with the American Association for the Surgery of Trauma (AAST) grade I and II splenic injuries to be treated using a NOM approach (grade I—92.1% and grade II—84.2%); however, no consensus was reached for grade III–V injuries in terms of management strategy. Similarly, the need for regional trauma centers that accept tertiary referrals to have the capacity to perform out-of-hours SAE reached a consensus (86.1%). There was near consensus on the following topics—71.3% would proceed to SAE if an established intraparenchymal active extravasation is seen on computed tomography (CT), and 71.3% would not reattempt SAE if unsuccessful and proceed to OM. Most respondents did not change management based on the age of the patient. The number of units of blood transfusions initially would influence the recommendation for SAE and OM in 66.3%, and moderate hemoperitoneum on CT would influence management in 57% of our respondents.
Conclusion: The management of splenic trauma is variable across the globe. Although consensus could be made across some decisions, there is still disagreement and particularly with high-grade injuries. With iterative surveys, we aim to reach a consensus on these issues, which will inform future practice.
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