It takes value from 0 to 163 and corresponds to data collected during the first 24 hours (e.g., age, chronic diseases, Glasgow coma score, systolic blood pressure, heart rate, body temperature, serum sodium and potassium levels). SAPS2 is a disease severity scoring system for patients admitted to intensive care units. It takes value from 0 to 75 and corresponds to the sum of the squared scores of the three most severely injured body regions. ISS is an anatomical scoring system for patients with multiple injuries. Population characteristics included age, circumstances of the injury, hemodynamic status, simplified acute physiology score 2 (SAPS2), injury severity score (ISS), splenic AAST grade injury ( 18), splenic vascular lesion (contrast extravasation, pseudoaneurysm, arteriovenous fistula), large hemoperitoneum ( 1, 19– 21), associated trauma lesions, and length of hospital stay. The medical data were collected from the patients’ computerized medical files. NOM or SAE failure was considered when a splenectomy was required.Īll imaging exams were archived in a picture archiving and communication system and were reviewed. However, the final management decision was left to the appreciation of the trauma team comprising an emergency care specialist, an emergency surgeon, and an interventional radiologist.
The indication for SAE was recommended in cases of splenic vascular lesions on CT, spleen injury AAST grade 4–5, or AAST grade 3 with severity factors (large hemoperitoneum, age ≥50 years, severe associated lesions). The spleen injury was graded on computed tomography (CT) using the American Association for the Surgery of Trauma (AAST) classification ( 18): (grade 1, hematoma 50% or laceration >3 cm with devascularization 25% grade 5, comminuted fracture or complete devascularization). The indication for OM was attributed to any hemodynamically unstable patients, despite adequate resuscitation. The objectives of this study were to compare outcomes of the three types of BSI management, determine if there are any complications statistically related to management methods, and demonstrate risk factors taking polytrauma into account. A better understanding of these complications could help in preventing them.
The severity of trauma and associated lesions could therefore be considered confounding factors resulting in treatment failure and complications. Certain authors have taken a specific interest in the parameters of multiple injuries and shown that lesions of associated organs (pancreas, spinal cord, limbs) were related to more complications ( 15– 17).
The severity of polytrauma is taken into account using the patients’ injury severity score (ISS), and several studies have shown that a high ISS was related to more nonsurgical treatment failures ( 14).
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The description and prevalence of these complications varies greatly from one series to another ( 7, 11– 13), resulting from the confusion existing between adverse events related to injury and those related to treatment. The complication rate in relation to different management methods (operative and nonoperative) continues to be debated. Three methods of splenic artery injury management can be defined: operative management (OM), nonoperative management (NOM), and nonoperative management with splenic artery embolization (SAE). Blunt splenic injury (BSI) has become more frequently managed nonoperatively over the years, with the results improved by the contribution of embolization, making it possible to treat active hemorrhages as well as prevent hemorrhages in high-grade trauma of the spleen without active bleeding ( 1– 10).
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