Angiography for blunt splenic trauma does not improve the success rate of nonoperative management

BACKGROUND: Splenic artery arteriography with possible therapeutic embolization (SAE) has been postulated to improve the success rate of nonoperative management of blunt splenic injuries and increase splenic salvage. Previous reports, however, have compared SAE with historical controls. We compared nonoperative success with SAE with a contemporaneous group treated nonoperatively without SAE. METHODS: Patients who suffered blunt splenic trauma from 2000 to 2004 were identified. Demographic and outcome data were abstracted. Data on the performance of SAE, type of vessel embolized, and success or failure of nonoperative management were collected. Analysis of variance, χ, and regression analysis were used to evaluate the impact of SAE on outcome. RESULTS: There were 570 patients who suffered blunt splenic trauma and 221 (39%) were treated operatively. There were 349 patients who were treated nonoperatively and 46 (13.2%) underwent SAE. SAE was more frequently used for patients with spleen Abbreviated Injury Score (AIS) ≥3 (31%) than AIS = 2 (6.7%). For patients with spleen AIS ≥3, there was no difference in age, gender, Injury Severity Score, or admission blood pressure between those who did or did not undergo SAE. The nonoperative success rate was similar for patients who did (79.3%) and those that did not (78.8%) undergo SAE. CONCLUSIONS: Patients who underwent splenic arteriography did not have improved nonoperative splenic salvage rates compared with a contemporaneous control group of similarly injured patients. Subsets of patients with blunt trauma may benefit from SAE but further study will be required to define these patients.