NWRC Contributors: Petros Yiannoullou, Katy Newton, Claire Hall, Lyndsay Pearce, Jane Hughes, Ashley Scrimshire, Andrew Macdonald
Trauma Audit Research Network Contributors: Tom Jenks, Omar Boumra, Fiona Lecky
Non-operative management (NOM) of blunt splenic injuries in adult trauma patients is an accepted treatment protocol having evolved from its successful use in children. The goal of NOM is to minimize the need for laparotomy and maximise the rate of splenic preservation. NOM may comprise of observation alone or splenic artery embolization (SAE). SAE is a catheter angiography based technique that utilizes embolic agents to reduce or arrest bleeding. It can improve the success of NOM regardless of grade of injury and volume of haemoperitoneum. However, studies from the United States have highlighted practice variance between trauma centres, which is associated with a difference in patient outcomes. To date, there is no data on the utilization or efficacy of SAE in England.
1. To assess outcomes of SAE since the Major Trauma Networks were established in 2012
2. To establish the utilization of and clinician attitudes towards SAE in the management of patients with blunt splenic injuries.
1. A dataset was drawn from the Trauma Audit Research Network database of all splenic injuries admitted to English and Welsh hospitals from 1st April 2010 to 31st March 2014. Demographic data, injury severity, treatment modalities and outcomes were collected. Management and outcomes were compared before and after RTNs were launched.
2. A survey was distributed through the British Society of Interventional Radiologists to all UK members aiming to identify availability of IR services in England, radiologists’ practice, and attitudes toward management of blunt splenic injury.
Following introduction of regional trauma networks, the use of splenic artery embolization for management of blunt splenic injury increased from 3.5% to 7.6% (p=0.001). A significant reduction in splenectomy rate was also observed (20% to 14.85%, p=0.012). Significantly more patients with polytrauma and blunt splenic injury were treated with splenic emblotherapy following 2012 (61.2% vs. 30%, p<0.0001). Increasing age, injury severity score, polytrauma, and a Charlson Comorbidity Index above 10 were predictors of increased mortality (p < 0.001).
116 responses from respondents affiliated with 23 of the 26 Major Trauma Centres in England were received. 79% of respondents reported availability of a single dedicated interventional radiology service. 50% provide interventional radiology cover to more than one hospital within the network. All offer arterial embolisation for BSI. Only 25% follow guidelines. In haemodynamically stable patients, respondents indicated an increased appetite for angioembolisation as the grade of splenic injury increased from 1–4 (12.5%-82.14%, p<0.01). In unstable patients or those with radiological evidence of bleeding, significantly more respondents would offer embolisation for grade 1-3 injuries (p<0.01), compared to similar injuries in stable patients. Significantly fewer respondents would offer embolisation for grade 5 compared to grade 4 injuries in unstable patients or those with evidence of bleeding.
The above work was presented as a poster at the British Interventional Radiology Meeting 12th-13th November 2015, London UK and has been published as two manuscripts in the Annals of the Royal College of Surgeons and in Injury. The following are the references for this work:
Collaborative Attitudes Towards Splenic Artery Embolisation in Trauma Following Introduction of the English Regional Trauma Networks. Yiannoullou P, Scrimshire A B, Steinberg L J, Hall C, Newton K, Pearce L, Hughes J, Khan N, Ashleigh R, Macdonald ADH on behalf of the North-West Research.
A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes? P Yiannoullou, C Hall, K Newton, L Pearce, O Bouamra, T Jenks, AB Scrimshire, J Hughes, F Lecky, ADH Macdonald. Ann R Coll Surg Engl. 2017;99:63–9
Interventional Radiology service provision and practice for the management of traumatic splenic injury across the regional trauma networks of England. J Hughes, AB Scrimshire, L Steinberg, P Yiannoullou, K Newton, L Pearce, C Hall, ADH Macdonald. Injury. 2017; 48(5):1031-1034