Contemporary Management of Blunt Splenic Trauma in Adults: An Analysis of the Trauma Quality Improvement Program Registry

Purpose To evaluate the effectiveness of management strategies for blunt splenic injuries in adult patients. Materials and Methods Patients 18 years and older with blunt splenic injuries registered via the Trauma Quality Improvement Program (2013-19) were identified. Management strategies initiated within 24 hours of hospital presentation were classified as watchful waiting (WW), embolization, surgery, or combination therapy. Patients were stratified by injury grade. Linear models estimated each strategy’s effect on hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality. Results Of 81,033 included patients, 86.3%, 10.9%, 2.5%, 0.3% of patients received WW, surgery, embolization, and combination therapy, respectively. Among patients with low-grade injuries and compared to surgery, embolization was associated with a shorter hospital LOS (9.4 days, Q < .001, Cohen’s d = .30) and ICU LOS (5.0 days, Q < .001, Cohen’s d = .44). Among patients with high-grade injuries and compared to surgery, embolization was associated with a shorter hospital LOS (8.7 days, Q < .001, Cohen’s d = .12) and ICU LOS (4.5 days, Q < .001, Cohen’s d = .23). Among patients with low- and high-grade injuries the odds ratios for in-hospital mortality associated with surgery compared to embolization were 4.02 (Q < .001) and 4.38 (Q < .001), respectively. Conclusions Among patients presenting with blunt splenic injuries and compared to surgery, embolization was associated with a shorter hospital LOS, shorter ICU LOS, and lower risk of mortality.