MANAGEMENT OF BLUNT SPLENIC TRAUMA - COMPUTED TOMOGRAPHIC CONTRAST BLUSH PREDICTS FAILURE OF NONOPERATIVE MANAGEMENT

Nonoperative management of blunt splenic trauma is widely accepted; ho wever, reported failure rates have ranged as high as 40%, There are fe w factors available to identify failures reliably. To characterize fai lures of nonoperative management better, we retrospectively reviewed 3 09 blunt splenic injuries treated at our level I trauma center over a 5-year period, Eighty-nine patients were initially managed nonoperativ ely (29%), and 12 patients failed this approach (13%), Upon review of the initial computed tomography scans, a hyperdense collection of cont rast media in the splenic parenchyma, or ''contrast blush,'' was noted in 8 of 12 (67%) patients who failed and in 5 of 77 (6%) of those who mere successfully managed nonoperatively (p < 0.0001), These data sug gest that the presence of a contrast blush is an important considerati on when deciding the method for management of the splenic injury, If t hese results are confirmed in a prospective fashion, the failure rate of nonoperative management of blunt splenic trauma could be reduced by identification of the contrast blush.