Philippe Chu MD, Presenter: Nothing to Disclose

Ernesto Jose Ayala MD, Abstract Co-Author: Nothing to Disclose

Razia Rehmani MD, Abstract Co-Author: Nothing to Disclose

Nalini Kanth MD, Abstract Co-Author: Nothing to Disclose

To review the experience of conservative nonoperative management of splenic injury at our community-based level 1 trauma center and evaluate the current CT criteria for grading splenic injury.

We retrospectively and prospectively reviewed trauma CT workups performed at our community-based level 1 trauma center over the last 5 years. Over 2500 examinations were reviewed, of which 93 demonstrated splenic injury. Each case was re-graded by two experienced body imagers based on current CT grading criteria. The clinical management and outcome was then correlated to the updated CT grade in each case.

93 splenic injuries were identified, of which 82 were successfully managed without additional intervention. 3 of these cases developed pseudoaneurysms, which were observed through follow-up examinations. 11 cases had further intervention: 4 cases underwent splenectomy, 1 each with grade 2 and 3 injury, and 2 with grade 4b injury; and 7 cases underwent angiography, 2 with grade 4a and 5 with grade 4b injury, of which 3 proceeded to embolization (1 of the grade 4a and 2 of the grade 4b injuries). Overall, most of the lower grade injuries (1 through 3) were successfully managed nonoperatively. The higher grade injuries with evidence of active contrast extravasation appropriately received further intervention. The current CT grading criteria proved to be useful for predicting success of nonsurgical management; however, we identified many cases that could not be easily graded based on the current criteria. We identified 12 cases with multiple lacerations of different sizes that were grouped into lower than expected grades based on current criteria. There is no current criteria for easy inclusion of cases demonstrating maceration (13 cases), contusion (11 cases), or infarct (3 cases). 4 cases could not be graded because they did not have features that fit the current CT grading criteria.

The current CT grading criteria for splenic injury was useful for predicting the success of nonsurgical management and correlated well with the more conservative approach to managing splenic injury employed at our institution. We found that several additional inclusion criterion may need to be incorporated to make the current CT grading system for splenic injury more usable.

Current CT grading criteria is useful for predicting success of conservative nonoperative management of splenic injury.

Chu, P, Ayala, E, Rehmani, R, Kanth, N, Traumatic Splenic Injury: A Review of the CT Grading System and Nonoperative Management of Splenic Injury at a Community-based Level 1 Trauma Center.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8000610.html