Angiography is yet another tool for use in the management of splenic injury. Over the past decade, it has helped improved splenic salvage rates into the mid-90% range. Angio can be used selectively (for very specific indications) or nonselectively (routinely).
The University of Tennesse – Memphis tried to examine whether there was any benefit to more frequent, nonselective use of this tool. They analyzed data in the National Trauma Data Bank (NTDB). They excluded patients with early splenectomy (within 6 hours). Selective vs nonselective use was determined by looking at the percentage of patients from a specific hospital that underwent the procedure. Low or no use hospitals used it from 0-20% of the time, and high use hospitals used it in >20% of cases.
Here are the factoids:
- 7412 records were analyzed
- There was no difference in splenic salvage rates in low vs high angio use centers
- Higher overall injury severity and AIS 5 for spleen was associated with higher delayed splenectomy
Bottom line: Not a very enlightening analysis. The researchers equated high utilization with non-selective utilization, which is a big flaw. The numbers are large, but the underlying assumptions are weak. And we already knew that higher injury severity and higher grade spleen injury equals higher splenectomy rate.
I recommend that any center that uses angiography as an adjunct to management of splenic injury to have specific indications (grade, degree of hemoperitoneum, CT contrast extravasation, etc). This ensures uniform use of this tool, and helps optimize the risk:benefit ratio to improve patient safety.
Reference: Are we lemmings?: Nonselective use of angiography provides no benefit in high-grade splenic injury. AAST 2013, Paper 12.