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Role of Repeat Computerized Tomography in the Selective Non-Operative Management of Splenic Trauma

Ferguson R, Lin J, Tunzi M, Donn E and McCague A

Splenic injuries are some of the most common injuries accompanying blunt abdominal trauma. Non-operative management (NOM) of these injuries is a standard of care for hemodynamically stable patients. Computed Tomography (CT) imaging is helpful in evaluating solid organ trauma and determining treatment options; however, indications for follow up CT scans are unclear. Current guidelines at our Level II Trauma Center recommend that a repeat CT scan should be performed for patients undergoing NOM of splenic injuries Grade III and above at 48 hours from admission-including those that undergo embolization. This 2-year retrospective study assessed the role of repeat CT scans in NOM by analyzing the indications for surgery in NOM failures.NOM was undertaken in 35 patients with splenic trauma of Grade III or higher. Scans were repeated in 28 (80%) patients with a median time of 65.68 hours. There was failure of NOM (NOMF) in 4 patients. All patients had clinical deterioration along with follow-up imaging prior to delayed surgery. The data suggests that repeat CT scans have a limited role in NOM of splenic trauma. Although this study is limited by our small sample size, we propose that instead of mandatory repeat CT scans, clinical judgment should be exercised to avoid unnecessary radiation exposure in clinically stable patients. This study prompts further questions concerning the role of repeat computerized tomography in blunt splenic trauma and illustrates the need for a larger multicenter trial to address this question as well.