Patient factors associated with embolization or splenectomy within 30 days of initiating surveillance for splenic trauma

• DOI: 10.1007/s10140-024-02285-3
• Publication Date: 2024-10-04T04:11:42Z
• Authors: Fatah Tidadini; Eugenie Martinet; Jean-louis Quesada; Alison Foote; Chayma El Wafir; Edouard Girard; Catherine Arvieux; ; Julio Abba; Irchid Al-naasan; Charles Aarteaga; Sandrine Barbois; Thierry Bege; Jean-Paul Bergi; Matthieu Biais; Guillaume Bouhours; Antoine Bouvier; Jean-Luc Bosson; Pierre Bouzat; Katia Chaumoitre; Jonathan Charbit; Raphael Cinotti; Philippe Cluzel; Philippe Compagnon; François Cotton; Myriam Coutard; Jean Louis Daban; Charles Daragon; Jean-Stéphane David; Frederic Douane; Vincent Dubuisson; Anne Ego; Patrice Fernandez; Julien Frandon; Delphine Garrigue; Julien Guelfi; Françoise Guillon; Marc Haberlay; Hassen Hentati; Christophe Henry; Emmanuel Hornez; Hicham Kobeiter; Nicolas Huet; Yann Lebras; Marie-Christine L...; Marc Leone; Emilie Lermite; Nathalie Lesavre; Albrice Levrat; Thomas Martinilli; Eric Meaudre; Jean-Philippe Mes...; Sylvie Metairie; Marie Michoud; Tristan Monchal; Valérie Monnin-Bares; Laurent Muller; Jean-Robert Nzamushe; Guillaume Passot; Julien Picard; Isabelle Plenier; Bertrand Prunet; Mathieu Raux; Catherine Ridereau; Mathieu Rodiere; Christophe Teriit...; Melanie Terebus-l...; Jean-Marc Thouret; Frédéric Thony; Christophe Tresallet; Pierre-Jean Valette; Antoine Vilotitch; Eric Voiglio; Grenoble Alpes; Nîmes; Bordeaux; Angers; Lyon Sud; Montpellier; Nantes; Pitié-Salpêtrière; Pitié-Salpêtrière...; Henri-Mondor Créteil; Annecy-Genevois; Valence; Chambéry; Percy; Sainte-Anne Toulon
• Keywords: [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology; 616; 617; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology

Non-operative management of hemodynamically stable patients with splenic trauma has been recommended for more than 25 years, but in practice embolization and/or splenectomy (intervention) is often needed within the first 30 days. Identifying the risk factors associated with the need for intervention could support more individualized decision-making.We used data from the SPLASH randomized clinical trial, a comparison of outcomes of surveillance or embolization. 140 patients were randomized, 133 retained in the study (embolization n = 66; surveillance n = 67) and 103 screened and registered in the non-inclusion register. Multivariate Cox proportional hazards models with time-varying covariates were used to identify risk factors contributing to embolization and/or splenectomy within 30 days after initiating surveillance only for splenic trauma.123 patients (median age, 30 [23; 48] years; 91 (74%) male) initially received non-operative management. At the day-30 visit, 34 (27.6%) patients had undergone an intervention (31 (25.2%) delayed embolization and 4 (3.3%) splenectomy). Multivariate analysis identified patients with OIS grade 4 or 5 splenic trauma (HR = 4.51 [2.06-9.88]) and (HR = 34.5 [6.84-174]); respectively) and splenic complications: arterial leak (HR = 1.80 [1.45-2.24]), pseudoaneurysm (HR = 1.22 [1.06-1.40]) and pseudocyst (HR = 1.41 [1.21-1.64]) to be independently associated with increased risk of need for an intervention within 30 days of initiating surveillance.Our study shows that more than 1 in 4 patients who received non-operative management needed embolization or splenectomy by day 30. Arterial leak, pseudoaneurysm, pseudocyst, and OIS grade 4 or 5 were independent risk factors linked to the need for an intervention.clinicaltrials.gov Identifier NCT02021396.