Patient selection: blunt abdominal trauma with FAST evaluation (Focused Assessment with Sonography for Trauma)
Parameters:
(1) hemodynamic status
(2) splenic injury identified on contrast-enhanced multi-detector CT (MDCT)
(3) presence of active bleeding and/or vascular injury associated with the spleen
(4) presence of other factors (head injury, coagulopathy)
(5) Grade of splenic trauma (from 1 to 5, see above)
(6) findings on splenic arteriography
Patients should undergo surgery:
(1) hemodynamically unstable
Patients who can be observed - all of the following:
(1) hemodynamically stable
(2) one of the following
(2a) (no active bleeding or vascular injury on MDCT) AND (splenic injury Grade 1 or 2)
(2b) (active bleeding or vascular injury on MDCT) AND (no active bleeding or vascular injury on splenic arteriography)
(2c) (no active bleeding or vascular injury on MDCT) AND (splenic injury Grade 3 to 5) AND (no active bleeding or vascular injury on splenic arteriography) AND (no other factors)
Patients who can be managed with embolization
(1) hemodynamically stable
(2) one of the following
(2a) (active bleeding or vascular injury on MDCT) AND ((active bleeding or vascular injury on splenic arteriography) OR (other factors))
(2b) (no active bleeding or vascular injury on MDCT) AND (splenic injury Grade 3 to 5) AND ((active bleeding or vascular injury on splenic arteriography) OR (other factors))
A key feature of the analysis is that splenic arteriography is needed to evaluate a patient with high Grade injury, since not all vascular injuries can be detected with MDCT
