American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings.

Autor:	Lee JT; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Slade E; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Uyeda J; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Steenburg SD; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Chong ST; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Tsai R; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Raptis D; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Linnau KF; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Chinapuvvula NR; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Dattwyler MP; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Dugan A; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Baghdanian A; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Flink C; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., Baghdanian A; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.)., LeBedis CA; From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.).
Jazyk:	angličtina
Zdroj:	Radiology [Radiology] 2021 Apr; Vol. 299 (1), pp. 122-130. Date of Electronic Publication: 2021 Feb 02.
DOI:	10.1148/radiol.2021202917
Abstrakt:	Background Treatment of blunt splenic trauma (BST) continues to evolve with improved imaging for detection of splenic vascular injuries. Purpose To report on treatments for BST from 11 trauma centers, the frequency and clinical impact of splenic vascular injuries, and factors influencing treatment. Materials and Methods Patients were retrospectively identified as having BST between January 2011 and December 2018, and clinical, imaging, and outcome data were recorded. Patient data were summarized descriptively, both overall and stratified by initial treatment received (nonoperative management [NOM], angiography, or surgery). Regression analyses were used to examine the primary outcomes of interest, which were initial treatment received and length of stay (LOS). Results This study evaluated 1373 patients (mean age, 42 years ± 18; 845 men). Initial treatments included NOM in 849 patients, interventional radiology (IR) in 240 patients, and surgery in 284 patients. Rates from CT reporting were 22% (304 of 1373) for active splenic hemorrhage (ASH) and 20% (276 of 1373) for contained vascular injury (CVI). IR management of high-grade injuries increased 15.6%, from 28.6% (eight of 28) to 44.2% (57 of 129) (2011-2012 vs 2017-2018). Patients who were treated invasively had a higher injury severity score (odds ratio [OR], 1.04; 95% CI: 1.02, 1.05; P < .001), lower temperature (OR, 0.97; 95% CI: 0.97, 1.00; P = .03), and a lower hematocrit (OR, 0.96; 95% CI: 0.93, 0.99; P = .003) and were more likely to show ASH (OR, 8.05; 95% CI: 5.35, 12.26; P < .001) or CVI (OR, 2.70; 95% CI: 1.64, 4.44; P < .001) on CT images, have spleen-only injures (OR, 2.35; 95% CI: 1.45, 3.8; P < .001), and have been administered blood product for fewer than 24 hours (OR, 2.35; 95% CI: 1.58, 3.51; P < .001) compared with those chosen for NOM, after adjusting for key demographic and clinical variables. After adjustment, factors associated with a shorter LOS were female sex (OR, 0.84; 95% CI: 0.73, 0.96; P = .009), spleen-only injury (OR, 0.72; 95% CI: 0.6, 0.86; P < .001), higher admission hematocrit (OR, 0.98; 95% CI: 0.6, 0.86; P < .001), and presence of ASH at CT (OR, 0.74; 95% CI: 0.62, 0.88; P < .001). Conclusion Contained vascular injury and active splenic hemorrhage (ASH) were frequently reported, and rates of interventional radiologic management increased during the study period. ASH was associated with a shorter length of stay, and patients with ASH had eight times the odds of undergoing invasive treatment compared with undergoing nonoperative management. © RSNA, 2021 See also the editorial by Patlas in this issue.
Databáze:	MEDLINE
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