Splenic injury diagnosis & splenic salvage after trauma

Non-operative management (NOM) has replaced surgery as the treatment of choice for hemodynamically stable patients with splenic injury after trauma. The growing use of NOM for blunt abdominal organ injury has been made possible by the progress in the quality and availability of the multidetector CT scan and the development of minimally invasive intervention options such as splenic artery embolization (SAE).
This thesis contributed to the further refinement of patient selection for the (non-)operative treatment of blunt splenic injury after trauma. The challenge is to use the least invasive techniques to control life threatening haemorrhage as quickly as possible (‘Time is life’) in order to reduce the number of unnecessary splenectomies. This maximises patient benefit while maintaining high standards of safety.
The most important findings of this thesis are:
• If 24/7 interventional radiology facilities are available, SAE is not associated with time loss compared to splenic surgery, even in patients who are HD unstable upon presentation.
• After correction for confounders with the propensity score technique, there was a small, but consistent advantage of SAE over observation alone with regard to successful treatment in patients with blunt splenic injury after trauma.
• From a prospective study we concluded that splenic function of embolised patients is intact and routine vaccination appears not to be indicated.
• Lastly, one of the studies showed that variation in treatment and outcome of splenic injury exists in the Netherlands. The development of a national guideline is advised to minimalize splenectomy after trauma.