J.M. York1, E. Biesboer1, A. Rasheed1, A.H. Al Tannir1, E. Fair1, N. Kulkarni1, M. Griffin1, P. Patel1, T. Carver1 1Medical College Of Wisconsin, Milwaukee, WI, USA
Introduction:
The 2018 revision of the AAST spleen organ injury scale primarily differs from the 1994 scale in that vascular injury is factored into the injury grade. This grading scale is widely used for clinical decision-making and may influence the decision to perform intervention. Despite this, use of the 2018 grading scale is not universal within our institution, and we therefore sought to evaluate whether the 2018 vs 1994 scale is a better predictor of failure of non-operative management (NOM) in blunt splenic injury (BSI).
Methods:
A retrospective review of all patients with a BSI that underwent initial NOM from 1/2017 – 12/2021 was performed. Initial CT scans were independently re-read by fellowship-trained radiologists to determine the AAST 2018 and 1994 grades and other splenic injury imaging findings. Failure of NOM was defined as any intervention to control splenic hemorrhage. Logistic regression was used to evaluate predictors of NOM failure.
Results:
363 patients with a splenic injury underwent initial NOM, and 18 (4.8%) failed NOM. 2018 grading resulted in higher grade injuries in 56 patients, with most being upgraded from 3 to 4 (n=38, 10.0%) and 3 to 5 (n=12, 3.1%). The 1994 (OR=3.61 95%CI=0.27-4.80, p<0.001) and 2018 (OR=3.88 95%CI=0.27-4.94, p<0.001) grades correlated similarly with failure of NOM. Presence of contrast extravasation was the strongest predictor of failure (OR:15.9 95%CI=4.79-68.69, p<0.001) but other blush characteristics were not associated with failure of NOM.
Conclusion:
Despite the changes modifications to the AAST splenic injury grade, the 2018 system does not significantly improve the association of grade and failure of NOM. Contrast extravasation is associated with a significant OR for failure of NOM and may need to be considered separate from grade when making clinical decisions in the management of BSI.