CT-based grading system leads to improved decisions in splenic injury

Adding a multidetector CT-based grading scale system when examining splenic injury patients at triage yields better results for providers making care decisions, according to a study published online Dec. 3 in Radiology.

Lead author Nitima Saksobhavivat, MD, of Ramathibodi Hospital in Bangkok, Thailand, and colleagues noted that when it comes to blunt splenic injury, CT results alone are a poor predictor of how successful non-surgical treatment will be. The team reported that a 2006 study by Marmery et al suggested the use of a grading system that would incorporate nonbleeding vascular injury and bleeding splenic injury.

Looking to incorporate a grading system and technology that could potentially catch bleeding and nonbleeding vascular injuries, the team sought to assess the effectiveness of adding multidetector CT to a splenic injury grading system.

“A retrospective study was performed to assess the use of a dual-phase multidetector CT–based grading system alone and in combination with assessment of clinical parameters at triage of patients with blunt splenic injury to help in the determination of appropriate treatment,” Saksobhavivat and colleagues wrote.

Conducted between 2011 and 2013, the study focused on 171 patients who underwent multidetector CT after which triage clinical treatment decisions were made. Study patients received either observation, splenic intervention or splenic angiography.

Parameters used in evaluating patients and making clinical decisions included demographic data, vital signs, laboratory values, injury severity score, abbreviated injury severity, final treatment decision and success of nonsurgical treatment.

Results found that 50 percent of the patients went under observation, 11 percent received splenic intervention and 39 percent received splenic angiography.

Four patients underwent splenic artery embolization (SAE) after unsuccessful observation while six other patients received unsuccessful nonsurgical treatment with SAE.

None of the study patients who received observation required splenectomy.

”Areas under the receiver operating characteristic curve showed that the CT grading system was the best individual predictor of successful observation,” the researchers wrote.

The researchers concluded that the CT-based injury grading system was the single best predictor of treatment success and that most of the clinical variables used in the study were available at the time of the patient’s admission.

“The excellent performance of CT compared with clinical parameters in this study can be attributed not only to its ability to provide detailed description of the anatomic disruption to the splenic parenchyma but also to its ability to show important well-recognized splenic vascular lesions (active bleeding and nonbleeding vascular injury), a leading cause of unsuccessful nonsurgical treatment,” the authors wrote.