Correlation of operative and pathological injury grade with computed tomographic grade in the failed nonoperative management of blunt splenic trauma

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
J A CarrA Alzuhaili

Abstract

Computed tomography (CT) is the standard for grading blunt splenic injuries, but the true accuracy, especially for grade IV or V injuries as compared to pathological findings, is unknown. A retrospective study from 2005 to 2011 was undertaken. There were 214 adults admitted with blunt splenic injury and 170 (79%) were managed nonoperatively. The remaining 44 patients (21%) required surgical intervention. There was a significant difference in the Injury Severity Score (ISS) between those who did and those who did not require splenectomy: median 31 (interquartile [IQ] range 11-51) versus 22 (IQ range 9-35, p = 0.0002). Ten patients presented in shock, had a positive ultrasound, and went to surgery. The remaining 34 had CT scans prior to surgery. Twenty-five (73%) had injury grades IV or V. The CT scan correctly graded the injury in 14 (41%) and was incorrect in 20 (59%). The assigned grade by the CT scan underestimated the true injury grade by one grade in six cases (30%), by two or more grades in nine (45%), and the CT images were obscured by blood and deemed "ungradeable" in five (25%). The CT scan was more accurate for grades I and II (100%) than for grades III-V (25-43%). The reasons for inaccuracy were either inability to vi...Continue Reading

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Citations

Nov 17, 2012·The Surgical Clinics of North America·Jennifer Roberts, John A Weigelt
Aug 30, 2012·Seminars in Roentgenology·Jinxing YuRobert A Halvorsen
Aug 17, 2018·Annals of the Royal College of Surgeons of England·P RoyM Parik
Apr 2, 2020·World Journal of Emergency Surgery : WJES·Federico CoccoliniUNKNOWN WSES expert panel
Aug 23, 2017·World Journal of Emergency Surgery : WJES·Federico CoccoliniLuca Ansaloni

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