Olthof and others published reliability of injury grading systems for patients with blunt splenic trauma find, read and cite all the research you need on. At present, they are classified according to the anatomy of the injury. A and b, portal venous phase a and renal excretory phase b axial maximumintensityprojection mdct images show active bleeding arrowheads into peritoneum from splenic injury. Aast liver injury scale radiology reference article. However, 40% with grade iii, 38% with grade iv, and 40% with grade v injuries ultimately required splenectomy. Nop should only be considered in an environment that has capabilities to monitoring, serial exams and. The most accepted grading scale for splenic injury was established by the american association for the surgery of trauma in 1987 and revised in 1997 figure 1. The grading is based on the ct scan, operative, or autopsy findings. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. Guideline for the vaccination of patients with splenic.
Spleen problems and spleen removal some people are born without a spleen or need to have it removed because of illness or injury. Reliability of injury grading systems for patients with. Aast spleen injury scale 2018 revision uw emergency. Injury scoring scale a resource for trauma care professionals. In comparison to studies that were evaluating the use of embolization for nonoperative treatment strategies, the east multicenter study did not involve splenic embolization 8. Computer tomography grade of splenic injury is predictive of the time required for radiographic healing. In general, the lower the injury grade the more likely the patient can be managed nonoperatively. Up to 45% of patients with blunt abdominal trauma will have a splenic injury,1 which may require urgent operative management, angioembolisation, or nonoperative management in the form of active observation.
Advance one grade for multiple splenic injuries up to grade 3. Evaluation and management of splenic injury in blunt. Review of proximal splenic artery embolization in blunt. Spleen injury grading scale grade description icd9 ais90 i capsular tear, 3 cm parenchymal 865. Splenic salvage decreased with increasing splenic injury grade, but higher grade injuries grades iv and v still had a greater than 80% salvage rate. All grade ivv splenic injuries should undergo splenectomy due to the high risk of failure of nonoperative management with or without splenic embolization 2 and the need. The aast american association for the surgery of trauma liver injury scale, most recently revised in 2018, is the most widely used liver injury grading system 3 the 2018 update incorporates vascular injury i. Trauma is a major cause of morbidity and mortality. The american association for the surgery of trauma aast splenic injury scale, most recently revised in 2018, is currently the most widely used grading system for splenic trauma the 2018 update incorporates vascular injury i. The spleen is the most commonly injured organ in blunt abdominal trauma. Advance one grade for multiple injuries up to grade iii. Splenic rupture following colonoscopy is rare, first reported in 1974, with incidence of 121100,000. Dvt prophylaxis in solid organ injury summary it is well established that deep venous thrombosis dvt and pulmonary embolism pe are known complications in trauma patients.
This fact sheet explains what the spleen is, how to protect your spleen while it heals, warning signs to watch for, and how to manage pain. An update on nonoperative management of the spleen in. Wses classification and guidelines for adult and pediatric patients article pdf available in world journal of emergency surgery 121 august 2017 with 5,012 reads. Spleen injuries are among the most frequent trauma related injuries. More than one grade of splenic injury may be present and should be classified by the higher grade of injury.
The rupture of a normal spleen can be caused by trauma, such as a traffic collision. The spleen is an important part of the bodys defence against certain bacteria and infection. Time of injury to splenic embolization in hours range options include. Blunt splenic trauma the american association for the. It also filters blood and removes old blood cells and other debris. A splenic injury, which includes a ruptured spleen, is any injury to the spleen. Postoperative adhesions is a predisposing factor for splenic injury, and management is either. Ultrasound introduced in 1990s fast focused abdominal sonogram for trauma. Grade injury description icd9 ais 90 parenchymal disruption involving 25%75% of hepatic lobe or couinauds segments within a single lobe 864. Two widely used embolization approaches are proximal and.
The severity of the injury, suggested by grade ct grade, neurologic status, age 55 and or the presence of associated injuries are not contraindications to a trial of nop management. Spleen injury you have injured your spleen and it needs time to heal. Several retrospective and prospective studies recommended the use of agae in all hemodynamically stable patients with high grade splenic injuries 23, 9193. This guideline will need to be revisited on a yearly basis. A ruptured spleen is an emergency medical condition that occurs when the capsulelike covering of the spleen breaks open, pouring blood into your abdominal area. The spleen is the most frequently injured solid organ following blunt abdominal trauma and it represents around 35% and sometimes up to 50% of all abdominal solid organ injuries. There is significant evidence to support that dvts form early and frequently in trauma patients. Padis clinical practice guidelines for the prevention and management of pain, agitationsedation, delirium, immobility, and sleep disruption in adult patients in the icu a sccm guideline 2018. This guideline is written for individuals 12 years and older admitted to the maine medical center trauma service with splenic injury requiring splenectomy or splenic embolization. Objective to analyze national trends in the nonoperative management of pediatric splenic injury design retrospective cohort analysis patients all children and adolescents 18 years or younger from 2 national databases who were hospitalized with pediatric splenic injury setting data from 9 years of the national inpatient sample database 20002008 and 3 years of kids inpatient database. This varies from institution to institution but usually includes patients with stable hemodynamic signs, stable hemoglobin levels over 1248 hours, minimal transfusion requirements 2 u or less, ct scan injury scale grade of 1 or 2 without a blush, and patients younger than 55 years. Blunt aortic injuries accompany hepatic and splenic lesions in 1520% of cases fabian, hunt cit.
Guideline for the vaccination of patients with splenic injury requiring splenectomy or splenic embolization. Aast spleen injury scale radiology reference article. Splenic injuries, whether from penetrating trauma, such as a gunshot or knife wound, or from blunt trauma via motor vehicle crash or fall, are common and can be lethal. Recent nom protocols for splenic injuries debunk the removal of spleen from the equation myth. Medical management of grade 12 splenic injuries with active extravasation. Of the patients who underwent embo, none of those with grade i or ii injuries failed. Unstable patients undergo laparotomy and splenectomy. Splenic trauma by doctor saleem linkedin slideshare. The management of splenic trauma patients aims to restore the homeostasis and the normal.
The spleen is an organ in the upper left part of the abdomen. Optimization of selection for nonoperative management of. Splenic trauma,blunt trauma abdomen, spleen anatonmy ligaments blood supply accessory spleens, mechanism of injury, presentation symptoms and signs management operative vs non operative imaging techniques for spleen fast ct scan abdomen angiography, grades of splenic injury, criteria for non operative management, surgical management splenectomy vs. The severity of splenic injury can objectively be described with a grading system developed by the american association for the surgery of trauma 1. It is critical to anticipate splenic trauma during colonoscopy as one of the causes of abdominal pain after colonoscopy especially when located in the left upper quadrant or left shoulder. Spleen injuries are graded according to the depth of the contusion or the laceration, from grade i minor to grade iv shattering of the spleen. Prospective trial of angiography and embolization for all grade iii to v blunt splenic injuries. Splenic injury grading is presented in table 1 below. Injury scoring scale the american association for the. The spleen is a fistsized organ in the upper left side of your abdomen, next to your stomach and behind your left ribs. Generally, grades i and ii are considered as minor injuries. The management of splenic injuries has evolved over. The trend in management of splenic injury continues to favor nonoperative or conservative management.
The spleen, once thought expendable, is now viewed as a vital component of the immune system. Adult trauma surgeons have learned from their pediatric counterparts that non operative management is possible even with higher grade injuries. We will focus on blunt splenic injury which is often times the first or second most commonly injured solid organ in the abdomen along with the liver. Management determined by 1aast splenic injury grading 2presence of associated injuries 3hemodynamic stability 4age of patient and. Santaniellos study states that 33% of the patients with blunt aortic injury have associated simultaneous hepatic splenic lesions. In minor injuries with little bleeding, there may be abdominal pain. Or without the opportunity to define the grade of the splenic lesions before the surgical exploration. The management of splenic injuries has evolved over the. Stable patients with lower grade injuries are treated conservatively. The treatment method employed depends on the grade of splenic injury, heamodynamic stability of the patient, associated injuries, anaesthetic technique, laboratory backup and the experience of the surgeon. The indication for routine prophylactic agae in high grade splenic injuries is a matter of controversy 23, 68, 70, 74, 85, 9193. Wses classification and guidelines for adult and pediatric patients federico coccolini1. The diagnosis and management of splenic trauma has evolved over the past several decades.
1057 890 159 507 1063 329 197 378 148 31 17 709 934 129 720 1207 387 1137 90 1231 1443 1302 1272 1072 1238 1498 229 496 972 1066 48 1156 642 1429 586 723 840 231 1111 712 1152 553 1269