What are the guideline sources, guidelines and references for Splenic trauma ?
Guideline sources The following summarized guidelines for the evaluation and management of splenic trauma are prepared by our editorial team based on guidelines from the Society of Interventional Radiology (SIR 2020), the World Society of Emergency Surgery (WSES 2017), and the Eastern Association for the Surgery of Trauma (EAST 2012). 1 2 3 Guidelines 1. Diagnostic investigations Diagnostic imaging: As per WSES 2017 guidelines, decide on diagnostic technique at admission based on the hemodynamic status of the patient. A Show 5 more As per EAST 2012 guidelines, obtain abdominal CT with IV contrast in hemodynamically stable patients with blunt abdominal trauma without peritonitis, to identify and assess the severity of injury to the spleen. B https://web.pathway.md/diseases/recNpNUUVHH7La81n 1/5 6/24/23, 3:14 PM Splenic trauma Pathway Show 2 more 2. Medical management Non-operative management: As per WSES 2017 guidelines, attempt nonoperative management initially irrespective of injury grade in patients with hemodynamic stability and absence of other abdominal organ injuries requiring surgery. B Show 6 more As per EAST 2012 guidelines: Consider offering nonoperative management in patients with splenic injuries only in an environment providing capabilities for monitoring, serial clinical evaluations and an operating room available for urgent laparotomy. C Recognize that the following factors are not contraindications for attempting a trial of nonoperative management in hemodynamically stable patients with splenic injuries: severity of injury (as suggested by CT grade or degree of hemoperitoneum) neurologic status age > 55 years presence of associated injuries. B Thromboprophylaxis: As per WSES 2017 guidelines, consider performing mechanical thromboprophylaxis in all patients without absolute contraindication to its use. B Show 3 more As per EAST 2012 guidelines, consider administering pharmacologic prophylaxis to prevent VTE in patients with isolated blunt splenic injuries without increasing the failure rate of nonoperative management, although insufficient evidence on the optimal timing of safe initiation. C 3. Inpatient care Serial clinical and laboratory assessment: obtain clinical and laboratory observation associated to bed rest in the first 48-72 hours of follow-up in patients with moderate and severe lesions. B Serial imaging assessment: As per WSES 2017 guidelines, consider obtaining repeated CT during the admission in patients with: moderate and severe lesions or in decreasing hematocrit in the presence of vascular anomalies or underlying splenic pathology or coagulopathy neurological impairment. B https://web.pathway.md/diseases/recNpNUUVHH7La81n 2/5 6/24/23, 3:14 PM Splenic trauma Pathway As per EAST 2012 guidelines, use the following to decide on frequency of and need for follow- up imaging in patients with blunt splenic injury: clinical factors, such as persistent systemic inflammatory response increasing/persistent abdominal pain otherwise unexplained drop in Hgb. B 4. Therapeutic procedures Angioembolization: As per SIR 2020 guidelines: Consider performing splenic artery embolization in hemodynamically stable patients with grade IV/V blunt splenic trauma. C Consider performing embolization in hemodynamically stable patients with any grade injury with imaging or clinical evidence of ongoing splenic hemorrhage. B As per WSES 2017 guidelines, consider performing angiography/angioembolization in hemodynamically stable and rapid responder patients with moderate and severe lesions, and in patients with vascular injuries on CT (contrast blush, pseudoaneurysms, and arteriovenous fistula). B Show 8 more 5. Surgical interventions Indications for surgery: As per WSES 2017 guidelines, perform operative management in patients with hemodynamic instability and/or with associated lesions such as peritonitis or bowel evisceration or impalement requiring surgical exploration. B Show 4 more As per EAST 2012 guidelines: Perform urgent laparotomy in patients with diffuse peritonitis and in hemodynamically unstable patients after blunt abdominal trauma. A Do not perform routine laparotomy in hemodynamically stable patients without peritonitis presenting with an isolated splenic injury. D 6. Specific circumstances Pediatric patients (evaluation): insufficient evidence regarding the role of eFAST in the diagnosis of pediatric spleen injury. I Show 6 more Pediatric patients (non-operative management): offer nonoperative management as first-line therapy in hemodynamically stable pediatric patients with blunt splenic trauma. B https://web.pathway.md/diseases/recNpNUUVHH7La81n 3/5 6/24/23, 3:14 PM Splenic trauma Pathway Show 9 more Pediatric patients (angioembolization): do not perform angiography/angioembolization in the vast majority of pediatric patients with CT blush or moderate-to-severe injuries. D Show 3 more Pediatric patients (surgery): Perform operative management in case of hemodynamic instability, failure of conservative treatments, severe coexisting injuries necessitating intervention and peritonitis, bowel evisceration, impalement. B Attempt splenic preservation (at least partial) whenever possible. B Pediatric patients (follow-up): consider offering bed rest in hemodynamically stable pediatric patients without a drop in Hgb levels for 24 hours. C Show 4 more 7. Preventative measures Immunizations: provide immunization against the encapsulated bacteria (S. pneumoniae, H. influenzae, and N. meningitidis) in asplenic/hyposplenic patients. A Show 4 more Antimicrobial prophylaxis: Offer malaria prophylaxis in travelers. B Consider initiating antibiotic therapy in the event of any sudden onset of unexplained fever, malaise, chills or other constitutional symptoms, especially when medical review is not readily accessible. B 8. Follow-up and surveillance Follow-up: Consider obtaining follow-up CT after discharge in the presence of underlying splenic pathology or coagulopathy and in neurologically impaired patients. C Consider restricting activity for 4-6 weeks in patients with minor injuries and up to 2-4 months in patients with moderate and severe injuries. C References 1. Federico Coccolini, Giulia Montori, Fausto Catena et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017 Aug 18;12 40. Open 2. Nicole A Stassen, Indermeet Bhullar, Julius D Cheng et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73 5 Suppl 4 S294 300. Open https://web.pathway.md/diseases/recNpNUUVHH7La81n 4/5 6/24/23, 3:14 PM Splenic trauma Pathway 3. Siddharth A Padia, Christopher R Ingraham, John M Moriarty et al. Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma. J Vasc Interv Radiol. 2020 Mar;31 3 363 369.e2. Open https://web.pathway.md/diseases/recNpNUUVHH7La81n 5/5