Abstract
Objectives: To evaluate the impact of computed tomography contrast blush (CB) in the non-operative management (NOM) of blunt splenic injury (BSI)
Design: Retrospective study
Setting: Department of Surgery, College of Medicine, King Saud University, Saudi Arabia
Subjects and methods: All patients admitted with BSI from July 1, 2006 to June 30, 2014 were considered. Medical records were reviewed for patient's demography, vital signs, injury severity score, imaging, splenic injury grade, laboratory values, hospital and ICU stay, operations, blood transfusion, morbidity and mortality.
Main outcome measure: Determining the impact of CB in NOM of BSI
Results: A total of 187 patients with BSI underwent abdominal CT scan with intravenous contrast which revealed CB in 48 patients. A total of 20 patients, 14 from non-CB group and six patients with CB, developed hemodynamic instability and decline in the hemoglobin level. They underwent splenectomy. Patients with CB generally had a higher grade of splenic injury (p = 0.0203). Amongst patients with CB, those who failed NOM had a higher grade of splenic injury compared to those where NOM was successful (p = 0.0006).There was no significant difference in the failure rate of NOM and the mortality in both (CB & non-CB) groups. However, presence of CB didn't predict the failure of NOM.
Conclusions: Patients with CB had a higher grade of splenic injury. However, presence of CB does not predict worse outcome of NOM in low and high grade splenic injury. Clinical assessment is required to determine the management plan of individual patient with BSI.