The spleen is the most commonly injured organ in blunt abdominal trauma. (1) Management of blunt splenic injury includes conservative management, embolisation and splenectomy. (2) Management has progressively shifted towards non-operative management. This is due to factors including the increased risk of infection from encapsulated bacteria and surgical complications associated with splenectomy. (3, 4) Radiologists play a crucial role in determining injury severity by interpreting CT imaging. (1) The American Association for the Surgery of Trauma (AAST) injury scale is the most widely splenic injury...

Patients with blunt splenic trauma presenting between 01/01/2005 and 31/12/2017 were included in this study, with 208 patients in total. Patients who proceeded to surgery without CT imaging were excluded. At this institution, CT scans are performed using a split bolus. The portal venous phase provides optimal enhancement of the spleen and the arterial phase provides vascular detail. CT interpretation was provided by two separate radiologists. Clinical data and outcomes were provided by the Trauma Unit.

An AAST grade was provided in the original report in 99 studies (48.6%). There was evidence of vascular injury in 17 (17.2%) cases initially graded 1-3, and these were graded 4-5 by the second radiologist. In another 15 (15.2%) cases, there was a discrepancy in grading between the two radiologists. The proportion of patients managed with embolisation or splenectomy increased with grade; grade 1 (10/34, 29.4%), grade 2 (15/54, 27.8%), grade 3 (23/47, 48.9%), grade 4 (38/44, 86.4%) and grade 5 (28/29, 96.6%). Mortality increased...

Despite being the most widely used method for grading splenic injury severity, less than half of CT reports provided an AAST grade. A significant portion of injuries previously graded 1-3 should now graded 4-5 due to the incorporation of vascular injury in the 2018 update. There is some inter-observer variability in the use of the AAST scale. Accurate description of splenic injuries provides crucial information to trauma team, influencing management and provides a prognostic indicator.

1. Margari S, Garozzo Velloni F, Tonolini M, Colombo E, Artioli D, Allievi NE, et al. Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study. Emerg Radiol. 2018;25(5):489-97. 2. El-Matbouly M, Jabbour G, El-Menyar A, Peralta R, Abdelrahman H, Zarour A, et al. Blunt splenic trauma: Assessment, management and outcomes. Surgeon. 2016;14(1):52-8. 3. Olthof DC, van der Vlies CH, Goslings JC. Evidence-Based Management and Controversies in Blunt Splenic Trauma. Curr Trauma Rep. 2017;3(1):32-7. 4. Zarzaur...