31 - Freie Mitteilung
15. Mai 2019, 15:30 - 17:00, Szenario 1, 5. OG
Standard abdominal follow-up imaging has no advantage in the non-operative management of blunt splenic injury in adult patients
R. Liechti, M. Stickel, L. Fourie, B.-C. Link, J. Metzger, R. Babst, F. Beeres, Presenter: R. Liechti (Luzern)
To date, limited evidence exists regarding follow-up imaging during the non-operative management (NOM) of blunt splenic injury (BSI). The aim of this study was to investigate the incidence and time to failure of NOM as well as to evaluate the relevance of follow-up imaging.
All adult patients with BSI admitted to our level I trauma center, including two associated hospitals, between 01/01/2010 and 31/12/2017 were retrospectively analyzed. We reviewed demographic data, comorbidities, injury pattern, trauma mechanism, Injury Severity Score, splenic injury grade and free intra-abdominal fluid. Additional analysis of indication, frequency, modality, results and consequences of follow-up imaging was performed. Risk factors for failure of NOM were evaluated using fisher’s exact test. Potential differences of quantitative variables were evaluated using the Wilcoxon rank-sum test.
A total of 122 patients met inclusion criteria; 29 female (23.8%) and 93 male (76.2%), with a mean age of 43.8 ± 20.7 years (16-84 years). 20 patients (16.4%) underwent immediate intervention; 10 (8.2%) splenectomies, 4 (3.3%) spleen conserving surgeries, 6 (4.9%) angio-embolizations. 102 patients (83.6%) were treated by NOM. Failure of NOM occurred in 4 patients (3.9%). Failure was significantly associated with active bleeding (3 of 4 [75%] failures vs. 8 of 98 [8.2%] non-failures, OR 33.75, 95% CI 3.1, 363.2, p = 0.004), and liver cirrhosis (2 of 4 [50%] failures vs. 0 of 98 [0%] non-failures, OR 197, 95% CI 7.4, 5265.1, p = 0.001). 81 patients (79.4%) in the NOM-Group received follow-up imaging by ultrasound (US) or computed tomography (CT). In 58 cases, standard imaging examinations were conducted (43 US and 15 CT scans) without prior clinical deterioration. 56 (96.6%) of these imaging results revealed no new significant findings. None of the patients receiving standard imaging developed failure of NOM. Every failure was detected by CT scans which were conducted due to clinical deterioration during the first 48 hours. The 4 CT scans were performed significantly earlier than the other follow-up imaging examinations (p=0.011).
The present study indicates that a standard follow-up imaging in the NOM of BSI in adult patients has no therapeutic advantage. Follow-up imaging should be based on clinical findings and include either contrast enhanced CT or US.