Natural history of splenic vascular abnormalities after blunt injury

A Western Trauma Association multicenter trial

Ben L.L. Zarzaur, Julie A.A. Dunn, Brian Leininger, Margaret Lauerman, K. Shanmuganathan, Krista Kaups, Kirellos Zamary, Jennifer L.L. Hartwell, Ankur Bhakta, John G Myers, Stephanie Gordy, Samuel R.R. Todd, Jeffrey A.A. Claridge, Erik Teicher, Jason Sperry, Alicia Privette, Ahmed Allawi, Clay Cothren Burlew, Adrian A. Maung, Kimberly A. Davis & 5 others Thomas Cogbill, Stephanie Bonne, David H. Livingston, Raul Coimbra, Rosemary A.A. Kozar

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Following blunt splenic injury (BSI) there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with PSA or BLUSH. METHODS: Data was collected on adult (≥18) patients with BSI and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. RESULTS: Two hundred patients with a vascular abnormality on CT scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining, 59% underwent angiography and embolization (ANGIO) and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 CT scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist’s interpretation was 56.3%. Based on expert review the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a non-bleeding vascular injury. CONCLUSIONS: In this series, the vast majority of patients are managed with ANGIO and usually embolization while splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of non-operative failure no matter the strategy used for management. This group may warrant closer observation or an alternative management strategy. LEVEL OF EVIDENCE: Prognostic Level III

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - May 30 2017

Fingerprint

Nonpenetrating Wounds
Vascular System Injuries
Splenectomy
Natural History
Multicenter Studies
Blood Vessels
Angiography
Wounds and Injuries
Spleen
Hemorrhage
Trauma Centers
False Aneurysm
Observation
Demography

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Zarzaur, B. L. L., Dunn, J. A. A., Leininger, B., Lauerman, M., Shanmuganathan, K., Kaups, K., ... Kozar, R. A. A. (Accepted/In press). Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial. Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000001597

Natural history of splenic vascular abnormalities after blunt injury : A Western Trauma Association multicenter trial. / Zarzaur, Ben L.L.; Dunn, Julie A.A.; Leininger, Brian; Lauerman, Margaret; Shanmuganathan, K.; Kaups, Krista; Zamary, Kirellos; Hartwell, Jennifer L.L.; Bhakta, Ankur; Myers, John G; Gordy, Stephanie; Todd, Samuel R.R.; Claridge, Jeffrey A.A.; Teicher, Erik; Sperry, Jason; Privette, Alicia; Allawi, Ahmed; Burlew, Clay Cothren; Maung, Adrian A.; Davis, Kimberly A.; Cogbill, Thomas; Bonne, Stephanie; Livingston, David H.; Coimbra, Raul; Kozar, Rosemary A.A.

In: Journal of Trauma and Acute Care Surgery, 30.05.2017.

Research output: Contribution to journalArticle

Zarzaur, BLL, Dunn, JAA, Leininger, B, Lauerman, M, Shanmuganathan, K, Kaups, K, Zamary, K, Hartwell, JLL, Bhakta, A, Myers, JG, Gordy, S, Todd, SRR, Claridge, JAA, Teicher, E, Sperry, J, Privette, A, Allawi, A, Burlew, CC, Maung, AA, Davis, KA, Cogbill, T, Bonne, S, Livingston, DH, Coimbra, R & Kozar, RAA 2017, 'Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial', Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000001597
Zarzaur, Ben L.L. ; Dunn, Julie A.A. ; Leininger, Brian ; Lauerman, Margaret ; Shanmuganathan, K. ; Kaups, Krista ; Zamary, Kirellos ; Hartwell, Jennifer L.L. ; Bhakta, Ankur ; Myers, John G ; Gordy, Stephanie ; Todd, Samuel R.R. ; Claridge, Jeffrey A.A. ; Teicher, Erik ; Sperry, Jason ; Privette, Alicia ; Allawi, Ahmed ; Burlew, Clay Cothren ; Maung, Adrian A. ; Davis, Kimberly A. ; Cogbill, Thomas ; Bonne, Stephanie ; Livingston, David H. ; Coimbra, Raul ; Kozar, Rosemary A.A. / Natural history of splenic vascular abnormalities after blunt injury : A Western Trauma Association multicenter trial. In: Journal of Trauma and Acute Care Surgery. 2017.
@article{851fbbc04f1d4654ba5cded663b23054,
title = "Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial",
abstract = "BACKGROUND: Following blunt splenic injury (BSI) there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with PSA or BLUSH. METHODS: Data was collected on adult (≥18) patients with BSI and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. RESULTS: Two hundred patients with a vascular abnormality on CT scan were enrolled. Of those, 14.5{\%} were managed with early splenectomy. Of the remaining, 59{\%} underwent angiography and embolization (ANGIO) and 26.5{\%} were observed. Of those who underwent ANGIO, 5.9{\%} had a repeat ANGIO and 6.8{\%} had splenectomy. Of those observed, 9.4{\%} had a delayed ANGIO and 7.6{\%} underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 CT scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist’s interpretation was 56.3{\%}. Based on expert review the presence of an actively bleeding vascular injury was associated with a 40.9{\%} risk of splenectomy. This was significantly higher than those with a non-bleeding vascular injury. CONCLUSIONS: In this series, the vast majority of patients are managed with ANGIO and usually embolization while splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of non-operative failure no matter the strategy used for management. This group may warrant closer observation or an alternative management strategy. LEVEL OF EVIDENCE: Prognostic Level III",
author = "Zarzaur, {Ben L.L.} and Dunn, {Julie A.A.} and Brian Leininger and Margaret Lauerman and K. Shanmuganathan and Krista Kaups and Kirellos Zamary and Hartwell, {Jennifer L.L.} and Ankur Bhakta and Myers, {John G} and Stephanie Gordy and Todd, {Samuel R.R.} and Claridge, {Jeffrey A.A.} and Erik Teicher and Jason Sperry and Alicia Privette and Ahmed Allawi and Burlew, {Clay Cothren} and Maung, {Adrian A.} and Davis, {Kimberly A.} and Thomas Cogbill and Stephanie Bonne and Livingston, {David H.} and Raul Coimbra and Kozar, {Rosemary A.A.}",
year = "2017",
month = "5",
day = "30",
doi = "10.1097/TA.0000000000001597",
language = "English (US)",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Natural history of splenic vascular abnormalities after blunt injury

T2 - A Western Trauma Association multicenter trial

AU - Zarzaur, Ben L.L.

AU - Dunn, Julie A.A.

AU - Leininger, Brian

AU - Lauerman, Margaret

AU - Shanmuganathan, K.

AU - Kaups, Krista

AU - Zamary, Kirellos

AU - Hartwell, Jennifer L.L.

AU - Bhakta, Ankur

AU - Myers, John G

AU - Gordy, Stephanie

AU - Todd, Samuel R.R.

AU - Claridge, Jeffrey A.A.

AU - Teicher, Erik

AU - Sperry, Jason

AU - Privette, Alicia

AU - Allawi, Ahmed

AU - Burlew, Clay Cothren

AU - Maung, Adrian A.

AU - Davis, Kimberly A.

AU - Cogbill, Thomas

AU - Bonne, Stephanie

AU - Livingston, David H.

AU - Coimbra, Raul

AU - Kozar, Rosemary A.A.

PY - 2017/5/30

Y1 - 2017/5/30

N2 - BACKGROUND: Following blunt splenic injury (BSI) there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with PSA or BLUSH. METHODS: Data was collected on adult (≥18) patients with BSI and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. RESULTS: Two hundred patients with a vascular abnormality on CT scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining, 59% underwent angiography and embolization (ANGIO) and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 CT scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist’s interpretation was 56.3%. Based on expert review the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a non-bleeding vascular injury. CONCLUSIONS: In this series, the vast majority of patients are managed with ANGIO and usually embolization while splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of non-operative failure no matter the strategy used for management. This group may warrant closer observation or an alternative management strategy. LEVEL OF EVIDENCE: Prognostic Level III

AB - BACKGROUND: Following blunt splenic injury (BSI) there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with PSA or BLUSH. METHODS: Data was collected on adult (≥18) patients with BSI and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. RESULTS: Two hundred patients with a vascular abnormality on CT scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining, 59% underwent angiography and embolization (ANGIO) and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 CT scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist’s interpretation was 56.3%. Based on expert review the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a non-bleeding vascular injury. CONCLUSIONS: In this series, the vast majority of patients are managed with ANGIO and usually embolization while splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of non-operative failure no matter the strategy used for management. This group may warrant closer observation or an alternative management strategy. LEVEL OF EVIDENCE: Prognostic Level III

UR - http://www.scopus.com/inward/record.url?scp=85020232211&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020232211&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001597

DO - 10.1097/TA.0000000000001597

M3 - Article

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

ER -