B. Choi1, E. Warnack1, C. DiMaggio1, S. Frangos1, M. Bukur1, H. L. Pachter1, M. Klein1 1New York University School Of Medicine,Department Of Surgery,New York, NY, USA
Introduction: There is limited data regarding the safety and efficacy of nonoperative management for blunt splenic injury (BSI) with concomitant traumatic brain injury (TBI) despite its increased use over time. We studied trends in the treatment of combined TBI/BSI, hypothesizing that angioembolization would not lead to increased mortality.
Methods: Data were obtained from NIS-HCUP for 2004 to 2011, using ICD-9 codes to identify BSI, TBI, and treatment. Injury severity was assessed using International Classification of Injury Severity Scores (ICISS). In-hospital mortality for splenectomy and embolization groups was analyzed using logistic regression after controlling for year, age, gender, hospital teaching status, Charlson score, ICISS, and hypotension or shock at the time of presentation.
Results: Of 179,446 patients with BSI, 13,247 patients had associated TBI. The US population-based rate of TBI/BSI decreased by 0.02 injuries per 100,000 per year (P=0.09). 12.3% of TBI/BSI patients required splenectomy, while 6.1% underwent angioembolization. The rate of splenectomy decreased over the study period, from 16.6% to 8.0% (P<0.05) while the rate of embolization increased from 3.9% to 7.2% (P=0.22). Overall mortality in TBI/BSI patients was 17.1%, and did not change significantly over the study period (P=0.28). Mortality rate was lower in embolized patients (15.9%) than splenectomized patients (40.7%). Splenectomized patients had 2.75 times higher odds of death than all other TBI/BSI patients (95% CI 2.02-3.75, P<0.01), while embolized patients had no increased odds of death (OR 0.70, 95% CI 0.46-1.08, P=0.46).
Conclusion: Patients with combined BSI/TBI undergoing splenectomy carry a high mortality. For select patients, angioembolization has proven to be a safe and effective treatment option.