SURVEILLANCE IMAGING ASSOCIATED WITH DELAYED SPLENECTOMY IN HIGH-GRADE BLUNT SPLENIC TRAUMA

Objectives: There is limited data regarding need for surveillance Computed Tomography (CT) imaging for blunt splenic injury (BSI), which may result in unnecessary radiation exposure for patients. We sought to determine whether repeat CT had an impact on clinical decision making.

Methods: Retrospective chart review was conducted of all patients with BSI identified on CT scan admitted to a Level I trauma center (2016-2021). Grade I injuries and individuals who underwent emergent splenectomy or missing repeat CT imaging were excluded. Patient demographics, injury characteristics, initial and subsequent imaging characteristics, and procedures performed were collected. The primary outcome was need for intervention after subsequent imaging (defined as angioembolization and/or splenectomy) by high or low-grade injury.

Results: 400 individuals fit study criteria. Median time to repeat CT was 2 days from admission (IQR 2-3). There were 177 in the high-grade group (grade IV=167, V=10) and 223 in the low-grade group (II=129, III=94). Seventy-eight (20%) underwent intervention after repeat CT, from which 17% were in the low-grade group and 22.2% were in the high-grade group. There was no difference in likelihood of any intervention by injury grade. Individuals in the high-grade group, however, were 3.6 times more likely to undergo delayed splenectomy than those in the low-grade group (p=0.006). A new vascular lesion on repeat CT was identified in 62% of individuals who underwent delayed intervention, with these individuals having 23 times higher odds of intervention than those without a new lesion (p < 0.001).

Conclusion: Delayed intervention after surveillance imaging in blunt splenic injury is driven mostly by the identification of new vascular lesions and leads to greater rates of splenectomy in high versus low-grade injuries. Surveillance imaging should be considered for all AAST injury grades II or higher.