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Open Access 01-12-2022 | Computed Tomography | Review

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

Authors: Mauro Podda, Belinda De Simone, Marco Ceresoli, Francesco Virdis, Francesco Favi, Johannes Wiik Larsen, Federico Coccolini, Massimo Sartelli, Nikolaos Pararas, Solomon Gurmu Beka, Luigi Bonavina, Raffaele Bova, Adolfo Pisanu, Fikri Abu-Zidan, Zsolt Balogh, Osvaldo Chiara, Imtiaz Wani, Philip Stahel, Salomone Di Saverio, Thomas Scalea, Kjetil Soreide, Boris Sakakushev, Francesco Amico, Costanza Martino, Andreas Hecker, Nicola de’Angelis, Mircea Chirica, Joseph Galante, Andrew Kirkpatrick, Emmanouil Pikoulis, Yoram Kluger, Denis Bensard, Luca Ansaloni, Gustavo Fraga, Ian Civil, Giovanni Domenico Tebala, Isidoro Di Carlo, Yunfeng Cui, Raul Coimbra, Vanni Agnoletti, Ibrahima Sall, Edward Tan, Edoardo Picetti, Andrey Litvin, Dimitrios Damaskos, Kenji Inaba, Jeffrey Leung, Ronald Maier, Walt Biffl, Ari Leppaniemi, Ernest Moore, Kurinchi Gurusamy, Fausto Catena

Published in: World Journal of Emergency Surgery | Issue 1/2022

Abstract

Background

In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved.

Methods

Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM.

Results

Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I–II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II–III, AAST Grades III–V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries—WSES Class I, AAST Grades I–II) to 3 days (for high-grade splenic injuries—WSES Classes II–III, AAST Grades III–V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48–72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV–V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48–72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications.

Conclusion

This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.

Available only for authorised users

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Title: Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document
Authors: Mauro Podda
Belinda De Simone
Marco Ceresoli
Francesco Virdis
Francesco Favi
Johannes Wiik Larsen
Federico Coccolini
Massimo Sartelli
Nikolaos Pararas
Solomon Gurmu Beka
Luigi Bonavina
Raffaele Bova
Adolfo Pisanu
Fikri Abu-Zidan
Zsolt Balogh
Osvaldo Chiara
Imtiaz Wani
Philip Stahel
Salomone Di Saverio
Thomas Scalea
Kjetil Soreide
Boris Sakakushev
Francesco Amico
Costanza Martino
Andreas Hecker
Nicola de’Angelis
Mircea Chirica
Joseph Galante
Andrew Kirkpatrick
Emmanouil Pikoulis
Yoram Kluger
Denis Bensard
Luca Ansaloni
Gustavo Fraga
Ian Civil
Giovanni Domenico Tebala
Isidoro Di Carlo
Yunfeng Cui
Raul Coimbra
Vanni Agnoletti
Ibrahima Sall
Edward Tan
Edoardo Picetti
Andrey Litvin
Dimitrios Damaskos
Kenji Inaba
Jeffrey Leung
Ronald Maier
Walt Biffl
Ari Leppaniemi
Ernest Moore
Kurinchi Gurusamy
Fausto Catena
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Computed Tomography
Computed Tomography
Published in: World Journal of Emergency Surgery / Issue 1/2022
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-022-00457-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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