Splenic injury from blunt trauma
Javier Amador-Casta?eda, BHS, RRT, FCCM
| Respiratory Care Practitioner | Author | Speaker | Veteran | ESICM Representative, North America
Johannes Wiik Larsen, Kenneth Thorsen, Kjetil S?reide, Splenic injury from blunt trauma, British Journal of Surgery, Volume 110, Issue 9, September 2023, Pages 1035–1038, https://doi.org/10.1093/bjs/znad060
Summary of "Splenic Injury from Blunt Trauma"
Summary:
This article reviews the management of splenic injuries resulting from blunt trauma, one of the most common solid organ injuries. It highlights diagnostic approaches, severity scoring, and treatment strategies, emphasizing the importance of non-operative management (NOM) in most cases. Advanced imaging techniques and the role of angioembolization are discussed, alongside considerations for surgery, anticoagulation therapy, and vaccination in post-splenectomy or embolization cases.
Key Points:
1. Prevalence: Splenic injury is a frequent consequence of blunt trauma, requiring tailored management based on severity and hemodynamic stability.
2. Severity Scoring: The American Association for the Surgery of Trauma (AAST) Organ Injury Scale and World Society of Emergency Surgery (WSES) grading system are used to classify injuries.
3. Non-Operative Management (NOM): Up to 90% of isolated splenic injuries are managed non-operatively, including close monitoring and, in some cases, angioembolization.
4. Angioembolization Techniques: Proximal embolization reduces splenic perfusion pressure while preserving function, while distal embolization addresses focal injuries but increases ischemia risks.
5. Surgical Indications: Surgery is reserved for hemodynamically unstable patients or when NOM fails, with splenectomy being the definitive solution in severe cases.
6. Antithrombotic Therapy: Guidelines recommend initiating low molecular weight heparin (LMWH) within 24–72 hours based on injury severity to prevent venous thromboembolism.
7. Vaccination Needs: Post-splenectomy patients require vaccines against encapsulated bacteria to reduce infection risks, although vaccination after angioembolization is not routinely recommended.
8. Imaging Follow-Up: Routine imaging for asymptomatic low-grade injuries is unnecessary, but mandatory follow-up is advised for high-grade injuries.
9. Physical Activity Restrictions: Early mobilization is encouraged for low-grade injuries, with activity restrictions of up to 2–4 months for high-grade cases.
10. Challenges in Management: Older patients, those with comorbidities, or those on anticoagulation therapy require more vigilant monitoring and have a higher likelihood of NOM failure.
Conclusion:
Non-operative management is the preferred strategy for splenic injuries from blunt trauma, supported by angioembolization where necessary. Surgical intervention remains essential for hemodynamically unstable patients or NOM failures. The article underscores the importance of multidisciplinary care, personalized treatment, and adherence to updated guidelines to optimize outcomes.
Watch the following video on "Embolization Splenic Trauma 2020" by Gary Siskin
Discussion Questions:
1. How can decision-making algorithms for NOM and angioembolization be improved to better support individualized patient care?
2. What strategies can be implemented to ensure timely and appropriate vaccination for patients undergoing splenectomy or angioembolization?
3. How can future research address the limitations of current imaging techniques in monitoring splenic injury recovery?
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