Management of blunt splenic trauma: Computed tomographic contrast blush predicts failure of nonoperative management

M. J. Schurr, T. C. Fabian, M. Gavant, M. A. Croce, K. A. Kudsk, G. Minard, G. Woodman, F. E. Pritchard, L. D. Britt, M. G. Ochsner, M. B. Hawkins, J. Stanley Smith, G. S. Rozycki, M. Sugrue, D. Kissinger, F. R. Lewis

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Abstract

Nonoperative management of blunt splenic trauma is widely accepted; however, reported failure rates have ranged as high as 40%. There are few factors available to identify failures reliably. To characterize failures of nonoperative management better, we retrospectively reviewed 309 blunt splenic injuries treated at our level I trauma center over a 5-year period. Eighty- nine patients were initially managed nonoperatively (29%), and 12 patients failed this approach (13%). Upon review of the initial computed tomography scans, a hyperdense collection of contrast 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 were successfully managed nonoperatively (p < 0.0001). These data suggest that the presence of a contrast blush is an important consideration when deciding the method for management of the splenic injury. If these 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.

Original languageEnglish (US)
Pages (from-to)507-513
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume39
Issue number3
Publication statusPublished - Jan 1 1995

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All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Schurr, M. J., Fabian, T. C., Gavant, M., Croce, M. A., Kudsk, K. A., Minard, G., ... Lewis, F. R. (1995). Management of blunt splenic trauma: Computed tomographic contrast blush predicts failure of nonoperative management. Journal of Trauma - Injury, Infection and Critical Care, 39(3), 507-513.