Armonde Baghdanian MD, Presenter: Nothing to Disclose

Brian Michael Currie BS, Abstract Co-Author: Nothing to Disclose

Arthur Baghdanian MD, Abstract Co-Author: Nothing to Disclose

Christina Alexandra Lebedis MD, Abstract Co-Author: Nothing to Disclose

Stephan W. Anderson MD, Abstract Co-Author: Nothing to Disclose

Jorge A. Soto MD, Abstract Co-Author: Nothing to Disclose

Anthony Samuel Armetta MD, Abstract Co-Author: Nothing to Disclose

To determine if the CT Severity Index predicts the need for subsequent splenectomy in patients who undergo splenic artery embolization as the primary therapy of severe blunt splenic injuries.

This retrospective study was HIPAA compliant and IRB approved with waiver of informed consent. Twenty-five adult patients with blunt splenic trauma evaluated with abdominal CT between 1/1/2006 and 1/31/2013 who subsequently underwent and survived splenic artery embolization were included. The study population included 19 male and 6 female patients. Two radiologists retrospectively and independently reviewed the CT images and classified splenic injuries using the CT Severity Index: intraperitoneal active extravasation (grade 4b), intrasplenic vascular injury (grade 4a) and no vascular injury (grades 2 or 3). Another investigator reviewed the electronic medical records and documented whether or not each patient required splenectomy for definitive therapy. Two-tailed Fisher’s exact test was used to evaluate the association between the admission CT severity index and the success rate of splenic embolization as primary therapy (defined by stable patient discharge without the need for surgical splenectomy).

CT severity Indices: grade 4b (n=13), grade 4a (n=9), grade 3 (n=2) and grade 2 (n=1). Of the 25 patients, 21 recovered with no additional intervention and were determined to have a successful outcome: Ten with grade 4b, eight with grade 4a and three with grades 2 or 3. Four patients required splenectomy and the embolization procedure was deemed a failure: three with grade 4b and one with grade 4a. Thus, 10/13 (77%) patients with grade 4b and 11/12 (92%) patients with grade 2 to 4a injuries had successful embolization procedures as primary therapy. This difference was not statistically significant (p >.05).

The majority of patients with blunt splenic injury can be treated with arterial embolization and will not require a splenectomy. This includes patients with intraperitoneal active extravasation (CT severity index grade 4b).

Embolization can be used to successfully treat all types of vascular injuries in the spleen caused by blunt trauma, including free extravasation of contrast-enhanced blood into the peritoneal cavity.

Baghdanian, A, Currie, B, Baghdanian, A, Lebedis, C, Anderson, S, Soto, J, Armetta, A, Utility of the CT Severity Index for Determining the Outcome of Embolization as Primary Therapy for Severe Blunt Splenic Trauma with Splenic Injury.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003127.html