The prevalence of early contained vascular injury of spleen

• Published in: Scientific reports Vol. 14; no. 1; p. 7917
• Main Authors: Koskinen, Seppo K, Alagic, Z, Enocson, A, Kistner, A
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 04.04.2024; Nature Portfolio
• Subjects: Abdominal Injuries - diagnostic imaging; Abdominal Injuries - epidemiology; Abdominal Injuries - therapy; Arteriovenous fistula; Computed tomography; Contained vascular injury; CT scans; Embolization, Therapeutic; Fistulae; Humans; Longitudinal Studies; Medical records; Medicin och hälsovetenskap; Patients; Prevalence; Pseudoaneurysm; Retrospective Studies; Spleen; Splenectomy; Splenic Diseases; Trauma; Traumatic abdominal injury; Vascular System Injuries - diagnostic imaging; Vascular System Injuries - epidemiology; Wounds, Nonpenetrating - therapy; Spleen; Contained vascular injury; Arteriovenous fistula; Traumatic abdominal injury; Pseudoaneurysm; CT scans
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-58626-2

Contained vascular injuries (CVI) of spleen include pseudoaneurysms (PSA) and arterio-venous fistulae (AV-fistulae), and their reported prevalence varies. Our purpose was to assess the prevalence of early splenic CVI seen on admission CT in patients with splenic trauma admitted to a single level 1 trauma center in 2013-2021, and its detection in different CT protocols. A retrospective, single-center longitudinal cohort study. Nine-year data (2013-2021) of all patients with suspected or manifest abdominal trauma were retrieved. All patients, > 15 years with an ICD code for splenic trauma (S36.0XX) were included. CT and angiographic examinations were identified. Reports and images were reviewed. Splenic CVI CT criterion was a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Number of CVIs and treatment was based on medical records and/or available angioembolization data. Of 2805 patients with abdominal trauma, 313 patients (313/2805; 11.2%) fulfilled the study entry criteria. 256 patients (256/313; 81.8%) had a CT examination. Sixteen patients had splenectomy before CT, and the final study group included 240 patients (240/313; 76.7%). Median New Injury Severity Score (NISS) was 27 and 87.5% of patients had NISS > 15. Splenic CVI was found in 20 patients, which yields a prevalence of 8.3% (20/240; 95% CI 5.2-12.6%). In those cases with both late arterial and venous phase images available, CVI was seen in 14.5% of cases (18/124, 95% CI 8.6-22.0%). None of the patients with CVI died within 30 days of the injury. The prevalence of early splenic CVI in patients with a splenic trauma was 8.3-14.5% (95% CI 5.2-22.0%). Our data suggests that both arterial and venous phase are needed for CT diagnosis. The 30-day outcome in terms of mortality was good.