***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Nonoperative management ( NOM ) of patients with severe splenic injuries carries a significant risk of failure . We hypothesized that adding angiographic embolization ( AE ) to the NOM protocol would decrease the laparotomy rate , and increase the success rate of NOM and splenic salvage rate . METHODS A protocol introducing AE in the treatment of splenic injuries was implemented . AE was performed in OIS splenic injury grade s 3 to 5 and in all cases where signs of ongoing bleeding were encountered regardless of injury grade . Patients included in a prospect i ve study during a 24-month period were compared with a historic control group . RESULTS Group 1 ( before AE ) consisted of 69 patients with a mean Injury Severity Score ( ISS ) of 31 , and group 2 ( after introducing AE ) included 64 patients with a mean ISS of 30 . In group 1 , 30 patients underwent immediate laparotomy  ( 43 % ) , and the NOM success rate was 79 % . After introducing AE , 17 patients underwent immediate laparotomy  ( 27 % ; p = 0.04 ) , with a NOM success rate of 96 % ( p = 0.02 ) . Overall splenic salvage rate increased from 57 % to 75 % ( p = 0.02 ) . Angiography was performed in 31 patients in group 2 . Embolization was performed in 27 of these patients . AE failure rate was 4 % . NOM was successful in 14 of 15 patients with OIS injury grade s 4 and 5 after the introduction of AE ( 93 % ) . CONCLUSION A formal protocol adding m and atory AE to NOM for severe splenic injuries increased the percentage of patients in whom NOM was attempted , the NOM success rate , and the splenic salvage rate OBJECTIVE The purpose of this study was to compare the usefulness of two CT grading systems of blunt splenic trauma in predicting which patients need surgery or angioembolization . MATERIAL S AND METHODS Four hundred patients in hemodynamically stable condition admitted with blunt splenic injury were included in the study . All patients underwent contrast-enhanced MDCT . Grade of splenic injury was prospect ively assigned according to the American Association for the Surgery of Trauma ( AAST ) splenic injury scale . Patients were treated with surgical intervention , splenic arteriography with or without embolization , or observation alone . All MDCT images were retrospectively review ed and re grade d according to a novel grading system that specifically incorporates the findings of active bleeding or splenic vascular injury , including pseudoaneurysm and arteriovenous fistula . Receiver operating characteristics curves were generated with both grading systems for all splenic interventions , and statistical analyses were performed . RESULTS The area under the ROC curves for the new splenic grading system for splenic arteriography , surgery , and both interventions exceeded 80 % . The area under the curve for the new splenic grading system was greater than that for the AAST injury scale for all interventions . Differences were found to be statistically significant for splenic arteriography ( p = 0.0036 ) and the combination of arteriography and surgery ( p = 0.0006 ) . CONCLUSION The proposed CT grading system is better than the AAST system for predicting which patients with blunt splenic trauma need arteriography or splenic intervention BACKGROUND : Spleen artery embolization ( SAE ) increases the success of nonoperative management of spleen injury ; however , the immune alternation after SAE is unclear . This study search ed the endotoxin responses of peripheral blood mononuclear cells ( P BMC s ) in injured patients who received SAE .  METHODS : Patients were subsequently enrolled when their spleen injuries were confirmed by computed tomographic scan . Peripheral blood sample s were obtained within first , at third , fifth , and seventh postinjury days . P BMC s were isolated ; nuclear factor (NF)-kB translocations , phosphorylated I-kB expressions , and in vitro tumor necrosis factor (TNF)-alpha levels were assayed after endotoxin stimulation ( ES ) . RESULTS : Sixteen patients who received nonoperative managements were enrolled . Five patients received SAE ( embolized patients ) and 11 patients did not ( nonembolized patients ) . Compared with those in controls , NF-kB translocations , phosphorylated I-kB expressions , and TNF-alpha levels after ES decreased significantly early in injured patients . NF-kB translocation and TNF-alpha levels after ES were indifferent at seventh day between nonembolized patients and controls , whereas significantly lower NF-kB p65 translocation and TNF-alpha levels after ES were found at seventh postinjury day in embolized patients than in controls . Compared with nonembolized patients , embolized patients had significantly lower levels of NF-kBp50 translocations after ES from first to third postinjury days and lower levels of NF-kB p65 translocations , TNF-alpha , and phosphorylated I-kB expressions after ES from first to fifth postinjury days . CONCLUSIONS : SAE dysregulates the NF-kB system and aggravates the cytokine hyporesponse upon ES of P BMC s in patients with spleen injury . These results implicate that SAE alters immune response and may increase susceptibility to infections in injured patients With increasing technologic advances in interventional radiology , the vascular surgeon should be well versed in the indications , limitations , complications , and results of percutaneous transcatheter embolization for arterial trauma . Three hundred twenty-eight angiographically determined arterial injuries occurred in 242 patients from 1977 to 1984 in a major city hospital trauma center and were studied prospect ively . Transcatheter embolizations performed for 107 arterial injuries in 100 patients were successful in 82.2 % of injuries . Gelfoam , minicoils , microcoils , intimal dissections , or a combination of modalities was utilized . Anterior and posterior element pelvic fractures associated with hypotension and transfusion of 6 units or more of blood required embolization in 28 patients . Bleeding was controlled in 85.7 % of patients . Percutaneous transcatheter embolization was also effective in controlling 84.2 % of arteriovenous fistulas , 88.9 % of penetrating neck arterial injuries , and 73.3 % of postoperative intra-abdominal hemorrhage .  Therapeutic transcatheter embolization is a valuable adjunct to the vascular surgeon dealing with the spectrum of vascular trauma BACKGROUND Splenic injuries , like other blunt traumatic injuries , are increasingly treated with non-operative management . Angiographic embolization ( AE ) has emerged as an alternative modality for treatment of splenic injuries . We hypothesized that splenic embolization would lead to equivalent , if not improved , outcomes in terms of mortality , total costs , complications , and duration of stay . METHODS A retrospective review of a prospect i ve data set was performed for all adult splenic injuries admitted to our level I trauma center from 2000 through 2003 . Demographics , number of red cell units , emergency department hemodynamics , costs , and outcomes were examined . The operative group included those who  underwent computed tomography ( CT ) first then went to the operating room ( OR ) ( CT+OR ) or those who went directly to the OR . RESULTS There were 25 CT+OR and 24 AE patients of 164 blunt splenic injuries . After univariate analysis , higher injury severity score ( ISS ) , lower systolic blood pressure , lower pH , and higher packed red blood cell transfusions were associated with increased mortality and duration of stay . The splenic Abbreviated Injury Scale ( AIS ; mean + /- SD ) was the same for AE compared to CT+OR patients ( 3.8 + /- 0.4 vs 3.5 + /- 0.9 ) . Although the AE group was older ( 50 + /- 20 vs 36 + /- 13 years , P < .01 ) , Glasgow Comma Score ( 13 + /- 4 vs 11 + /- 5 ) , age , highest heart rate ( 109 + /- 24 vs 120 + /- 43 ) , and splenic AIS were not predictive of the need for an operation . Abdominal complications were lower in the AE group compared to the CT+OR ( 13 % vs 29 % ) , but mortality was not different ( 8 % vs 4 % ) . Total costs were similar for both groups after adjustment for ISS , GCS , pH , pretreatment transfusions , and spleen AIS ( AE , $ 49,300 + /- $ 40,460 vs CT+OR , $ 54,590 + /- $ 34,760 ) . The non-operative failure rate in this study was 2 % . CONCLUSIONS AE of splenic injuries is safe and associated with fewer complications . The spleen AIS , heart rate , age , and GCS did not correlate with the need for an operation . Higher ISS , lower blood pressure , lower pH , and increased number of packed red blood cell transfusions were better indicators of the need for an operation versus embolization BACKGROUND Nonoperative management ( NOM ) of blunt splenic injury is well accepted . Substantial failure rates in higher injury grade s remain common , with one large study reporting rates of 19.6 % , 33.3 % , and 75 % for grade s III , IV , and V , respectively . Retrospective data show angiography and embolization can increase salvage rates in these severe injuries . We developed a protocol requiring referral of all blunt splenic injuries , grade s III to V , without indication for immediate operation for angiography and embolization . We hypothesized that angiography and embolization of high- grade blunt splenic injury would reduce NOM failure rates in this population . STUDY DESIGN This was a prospect i ve study at our Level I trauma center as part of a performance-improvement project . Demographics , injury characteristics , and outcomes were compared with historic controls . The protocol required all stable patients with grade III to V splenic injuries be referred for angiography and embolization . In historic controls , referral was based on surgeon preference . RESULTS From January 1 , 2010 to December 31 , 2012 , there were 168 patients with grade s III to V spleen injuries admitted ; NOM was undertaken in 113 ( 67 % ) patients . The protocol was followed in 97 patients , with a failure rate of 5 % . Failure rate in the 16 protocol deviations was 25 % ( p = 0.02 ) . Historic controls from January 1 , 2007 to December 31 , 2009 were compared with the protocol group . One hundred and fifty-three patients with grade III to V injuries were admitted during this period , 80 ( 52 % ) patients underwent attempted NOM . Failure rate was significantly higher than for the protocol group ( 15 % , p = 0.04 ) . CONCLUSIONS Use of a protocol requiring angiography and embolization for all high- grade spleen injuries slated for NOM leads to a significantly decreased failure rate . We recommend angiography and embolization as an adjunct to NOM for all grade III to V splenic injuries Objective The authors review ed their experience with life-threatening blunt injuries in approximately 2900 children ( 0–14 years ) admitted to the design ated state pediatric shock trauma unit between 1990 and 1993 . Methods During this time , the authors treated all severely injured children with a prospect i ve , nonoperative protocol if they were hemodynamically stable after less than 40 mL/kg fluid replacement , had proven evidence of solid organ injuries and remained stable in the pediatric intensive care unit under surgical management . Results Twenty-eight children had computed tomography ( CT ) or operatively proven lacerations of the spleen , 25 had lacerations of the liver , 18 had lacerations of the kidney , 7 had lacerations of the pancreas , and 11 had two or more solid organ injuries . Three of the 28 children with injured spleens required  laparotomy  ( two splerectomy , one splenorrhaphy ) . Two of the 25 children with liver injuries required  laparotomy  ( one suturing , one partial resection ) . One of the 18 children with kidney injuries required  laparotomy  ( nephrectomy ) , and 3 of the 7 children with pancreas injuries required  laparotomy  ( two resection , one pseudocyst ) . There were three deaths after laparotomy ( two head , one chest/abdominal ) . There were no deaths in the children managed nonoperatively , and there were no immediate or long-range complications . Conclusions Comparison of the authors ' data with the National Pediatric Trauma Registry shows similar results . The authors believe that nonoperative management of solid organ injuries under careful surgical observation in a pediatric intensive care unit is safe and appropriate OBJECTIVES The aims of this study were to determine if angiographic findings can be used to predict successful nonoperative  therapy  of splenic injury and to determine if coil embolization of the proximal splenic artery provides effective hemostasis . METHODS Splenic injuries detected by diagnostic imaging between 1981 and 1993 at a level I trauma center were prospect ively collected and retrospectively review ed after management by protocol that used diagnostic peritoneal lavage , computed tomography ( CT ) , angiography , transc 
    Output:
    
Conclusions NOM+ SAE involves potential risks and operative management may be preferable to SAE for certain patients .