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A Survey of American Association for the Surgery of Trauma Member Practices in the Management of Blunt Splenic Injury

Zarzaur, Ben L. MD, MPH; Kozar, Rosemary A. MD, PhD; Fabian, Timothy C. MD; Coimbra, Raul MD, PhD

The Journal of Trauma: Injury, Infection, and Critical Care: May 2011 - Volume 70 - Issue 5 - p 1026-1031
doi: 10.1097/TA.0b013e318217080c
Original Article

Objective: Conflicting data exist regarding pseudoaneurysm screening (PSA-S), initial angioembolization (IE), deep venous thrombosis prophylaxis (DVT-P), and activity limitation after hemodynamically stable blunt splenic injury (BSI). To determine whether there was consensus regarding BSI management, the multi-institutional trial committee of the American Association for the Surgery of Trauma (AAST) approved a survey of member practice patterns regarding BSI management.

Methods: Over 2 months, AAST members were invited to participate in an online survey. Practice patterns and attitudes surrounding PSA-S, IE, DVT-P, and activity limitation after BSI were determined.

Results: The response rate was 37.5%. Practice patterns varied by injury grade. Observation only was thought appropriate for grades I (94.4%) and II (84.6%) injuries. For grades III to V injuries, fewer and fewer respondents felt observation only was appropriate. PSA-S was the most commonly used strategy for grades IV and V injuries (32.7% and 28.2%), and IE was thought to be appropriate by 23.5% of respondents for grade IV injuries and 25.5% of respondents with grade V injuries. Thirty percent of respondents felt that no DVT-P was indicated for adult patients with BSI. Recommendations regarding return to full activity varied by perceived risk to the patient and by injury grade.

Conclusions: There is considerable variation in the opinions of AAST members regarding BSI management, particularly for high-grade injuries. These results will aid in the design of prospective observational and random trials to determine optimal BSI management.

From the Department of Surgery (B.L.Z., T.C.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (R.A.K.), University of Texas Medical School at Houston, Houston, Texas; and Department of Surgery (R.C.), University of California San Diego, San Diego, California.

Submitted for publication December 23, 2010.

Accepted for publication February 23, 2011.

Presented as a poster presentation at the 69th Annual Meeting of the American Association For the Surgery Of Trauma, September 22, 2010, Boston, Massachusetts.

Address for reprints: Ben L. Zarzaur, MD, MPH. Department of Surgery, University of Tennessee Health Science Center, 910 Madison Bldg. 2nd Floor, Memphis, TN 38163; email: bzarzaur@uthsc.edu.

© 2011 Lippincott Williams & Wilkins, Inc.