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Extra-parenchymal splenic abnormalities not vascular injury predict need for primary splenectomy

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Abstract

Purpose

Radiographic indications for primary splenectomy (PS) in blunt splenic injury (BSI) after radiographic diagnosis are unknown. Improved understanding of radiographic characteristics of patients requiring splenectomy will help to appropriately triage patients to PS or non-operative management (NOM).

Methods

A retrospective, single-center review was performed of BSI diagnosed with computerized tomography (CT). Patients undergoing splenectomy prior to CT diagnosis were excluded.

Results

BSI was identified in 195 patients. On logistic regression, only subcapsular hematoma presence (OR 7.521, p = 0.002) and left upper quadrant hemoperitoneum (OR 6.146, p = 0.03) were associated with need for PS, while splenic laceration length, number of pseudoaneurysms (PSA), and active contrast extravasation (NS for all) were not.

Conclusions

Need for PS is predicted by extra-parenchymal pathology in subcapsular hematoma and hemoperitoneum. Splenic vascular injuries through PSA and active contrast extravasation do not predict the need for PS and can be considered for NOM.

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Authors and Affiliations

  1. Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA

    Margaret Lauerman, Nana Simpson, Deborah Stein & Thomas Scalea

  2. Department of Surgery, University of California Riverside School of Medicine, Moreno Valley, CA, 92555, USA

    Megan Brenner

  3. Division of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Kathirkamanthan Shanmuganathan

Authors
  1. Margaret Lauerman
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  2. Megan Brenner
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  3. Nana Simpson
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  4. Kathirkamanthan Shanmuganathan
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  5. Deborah Stein
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  6. Thomas Scalea
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Corresponding author

Correspondence to Margaret Lauerman.

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Conflict of interest

Dr. Brenner is on the clinical advisory board of Prytime Medical Inc.

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Lauerman, M., Brenner, M., Simpson, N. et al. Extra-parenchymal splenic abnormalities not vascular injury predict need for primary splenectomy. Eur J Trauma Emerg Surg 46, 1063–1069 (2020). https://doi.org/10.1007/s00068-019-01085-6

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  • DOI: https://doi.org/10.1007/s00068-019-01085-6

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