Vascular Trauma

Nonoperative Management of Adult Blunt Splenic Injury With and Without Splenic Artery Embolotherapy: A Meta-Analysis

Requarth JA, D’Agostino RB Jr, Miller PR (Wake Forest Univ Baptist Med Ctr, Winston Salem, NC; Wake Forest Univ Health Sciences, Winston Salem, NC) J Trauma 71:898–903, 2011^§

Abstract

Background

Observation and splenic artery embolotherapy (SAE) are nonoperative management (NOM) modalities for adult blunt splenic injury; however, they are quite different, inconsistently applied, and controversial. This meta-analysis compares the known outcomes data for observational management versus SAE by splenic injury grade cohort.

Methods

Thirty-three blunt splenic injury outcomes articles, published between 1994 and 2009, comprising 24 unique data sets are identified. Of these, nine gave outcomes data by splenic injury grade for observational management and SAE separately. Failure rates were collected and analyzed using random effects estimates.

Results

Overall, 68.4% of the 10,157 patients were managed nonoperatively. The overall failure rate estimate of NOM is 8.3% with a 95% confidence interval (CI) of 6.7% to 10.2%. The observational management failure rate estimate without SAE increases from 4.7% to 83.1% in splenic injury grade 1 to 5 patients. The overall failure rate estimate of SAE is 15.7% (95% CI, 10.4−23.2) and did not vary significantly from splenic injury grades 1 to 5 (p = 0.413). The failure rate of observational management without SAE is statistically higher than the failure rare estimate of SAE in splenic injury grade 4 and 5 injuries: 43.7% (95% CI, 25.5−63.8) versus 17.3% (95% CI, 7.8−34.1), p = 0.035 and 83.1% (95% CI, 45.2−96.7) versus 25.0% (95% CI, 8.7−53.8), p = 0.016, respectively.

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