COMPUTED TOMOGRAPHY-ASSISTED MANAGEMENT OF SPLENIC TRAUMA

BACKGROUND: In patients who have suffered an injury to the spleen, pre servation of the organ is of the utmost importance, To assist in manag ement, contrast-enhanced computed tomography (CT) has been used, We re viewed our experience with a protocol for nonoperative management of s plenic trauma based on CT grading of the injury, METHODS: During the i nitial period of the study, 50 CT examinations for blunt abdominal tra uma in adults were reviewed by staff radiologists for evidence of sple nic injury, The radiologists, blinded to clinical management decisions , graded the CT studies as ''A'' if there was a subcapsular hematoma o r capsular disruption, ''B'' if there was a parenchymal injury not ext ending into the hilum, or ''C'' if there was deep laceration of fractu re of the hilum, Following confirmation of the accuracy and reproducib ility of the grading scale, the splenic trauma management protocol was instituted, in which nonhilar injuries were managed nonoperatively. R ESULTS: In the initial assessment, patients managed nonoperatively had shorter hospital stays and received fewer blood transfusions than tho se undergoing operation. Among 30 patients subsequently enrolled in th e protocol, those treated nonoperatively remained in the hospital for fewer days than those treated surgically. Again, fewer units of blood and platelets were used in the non-operative group, Institution of the protocol decreased the incidence of celiotomy,CONCLUSIONS: The severi ty of splenic trauma evident on CT staging guides safe nonoperative ma nagement. Patients not suffering injury to the splenic hilum (A and B scores) can be managed without operation, resulting in shorter hospita l stays and fewer blood products used, (C) 1997 by Excerpta Medica, In c.