9 - THE AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA ORGAN INJURY SCALE FOR SPLEEN DOES NOT EQUALLY PREDICT INTERVENTIONS IN PENETRATING AND BLUNT TRAUMA
Director of Research John H Stroger, Jr. Hospital of Cook County, United States
Objectives: The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for the spleen (and other organs) was created in 1989. It has been validated to predict mortality, need for operation, length of stay (LOS), and intensive care unit (ICU) LOS. Our aim was to determine if the Spleen OIS is applied equally to blunt and penetrating trauma.
Methods: We analyzed the Trauma Quality Improvement Program (TQIP) database from 2017-2019, including patients with spleen injuries. Outcomes included the rates of mortality, operation, spleen-specific operation, splenectomy, and splenic embolization. Odds ratios and 95% Confidence Intervals (OR, CI) for outcomes were calculated for each grade compared to the immediately lower grade.
Results: 60900 patients had a spleen injury with an OIS grade. Mortality rates increased in Grades IV and V for both blunt (IV: OR 1.42, 1.28-1.58, V: 2.12, 1.88-2.38) and penetrating trauma (IV: 1.64, 1.13-2.38, V: 1.71, 1.24-2.36).
The odds for any operation, spleen-specific operation, and splenectomy increased, for each increase in grade in blunt trauma (p < 0.001). Penetrating trauma showed similar trends except for no statistically significant differences between grade IV and V (p>0.05). The rates of splenectomy were higher in penetrating trauma in grades I-II (OR 4.8, 3.7-6.2), III (OR 3.5, 2.8-4.4), IV (OR 1.9, 1.6-2.3), and V (OR 1.2, 1.0-1.5).
Splenic embolization was most frequent in Grade IV blunt trauma at 25%. Rates in penetrating trauma were significantly lower, most frequent in 2.5% of Grade III injuries. The rates of angioembolization were higher in blunt trauma in grades I-II (OR 3.2, 1.8-5.6), III (OR 7.0, 4.4-11.1), IV (OR 33.3, 15.6-71.4) and V (OR 52.6, 12.8-200).
On multivariate analysis, Grade V was associated with mortality. Grades III to V were significantly associated with operation, splenic operation, splenectomy, and splenic embolization. Mechanism of trauma is a significant factor for all outcomes, independent of AAST-OIS.
Conclusion: AAST-OIS does not equally predict outcomes in blunt and penetrating splenic injuries. Hemostasis is predominantly surgical in penetrating trauma, while it can be achieved with angioembolization more frequently in blunt trauma. Management of penetrating trauma is likely influenced by the potential for injury to peri-splenic organs.
