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Refining the role of splenic angiographic embolization in high-grade splenic injuries

BACKGROUND The justification and safety of splenic angiographic embolization (SAE) as an adjunct to nonoperative management (NOM) in high-grade splenic injuries are matters of controversy. At Oslo University Hospital-Ulleval, mandatory SAE was introduced in hemodynamically stable Organ Injury Scale (OIS) Grades 3 to 5 injuries in 2002. From October 2008, mandatory SAE was restricted to OIS Grade 4 injuries or higher. The aim of the present study was to evaluate clinical outcome in patients with high-grade splenic injuries and further define the role of SAE. METHODS All patients 17 years or older with splenic injury admitted from August 1, 2002, to July 31, 2010, were included. Patient charts, computed tomographic scans, and trauma registry data were reviewed. The OIS Grade 3 protocol was amended on October 1, 2008. RESULTS A total of 296 patients with splenic injuries (mean splenic OIS grade, 3.0) resulted in a 70% attempted NOM rate, with 96% success rate. NOM was attempted in 64 (70%) of 91 patients with Grades 4 and 5 injuries, with a 95% success rate. Comparing OIS Grade 3 injuries admitted before (n = 81) and after (n = 35) October 2008, we found similar admission physiology and Injury Severity Score (ISS). Despite the reduction in SAE rate (from 49% to 26%), the NOM rate remained unchanged, as did NOM failure rate (3% vs. 4%), rate of rebleeding, complications, and mortality. CONCLUSION A protocol with mandatory SAE in OIS Grades 4 and 5 injuries resulted in an overall 95% success rate among the 70% eligible for NOM. In OIS Grade 3 splenic injuries, mandatory SAE does not seem justified. LEVEL OF EVIDENCE Therapeutic study, level IV.