Consensus strategies for the nonoperative management of patients with blunt splenic injury: A Delphi study

BACKGROUND: Nonoperative management is the standard of care in hemodynamically stable patientswith blunt splenic injury.However, a number of issues regarding the management of these patients are still unresolved. The aim of this study was to reach consensus among experts concerning optimal treatment and follow-up strategies. METHODS: TheDelphimethodwas used to reach consensusamong 30 expert traumasurgeons and interventional radiologists fromaround theworld.An online survey was used in the two study rounds. Consensus was defined as an agreement of 80% or greater. RESULTS: Response rates of the first and second rounds were 90% and 80%, respectively. Consensus was reached for 43%of the (sub)questions. The American Association for the Surgery of Trauma organ injury scale for grading splenic injury is used by 93% of the experts. In hemodynamically stable patients, observation or splenic artery embolization (SAE) can be applied in the presence of a small or no hemoperitoneum combined with an intraparenchymal contrast extravasation or no contrast extravasation, regardless of the presence of an arteriovenous (AV) fistula/pseudoaneurysm. Hemodynamic instability is an indication for operativemanagement, irrespective of computed tomographic characteristics and grade of splenic injury (Q82% of the experts). Operative management is also indicated in the presence of associated intra-abdominal injuries and/or the need for five or more packed red blood cell transfusions (22 of 27 experts, 82%). Recommended time span to start SAE in a stable patient with an intraparenchymal contrast extravasation is 60 minutes (19 of 24 experts). Patients should be admitted 1 to 3 days to a monitored setting (27 of 27 experts, 100%). Serial hemoglobin checks are performed by all experts, every 4 to 6 hours in the first 24 hours and once or twice a day after that (21 of 24 experts, 88%), in nonoperativemanagement aswell as after SAE. Routine postdischarge imaging is not indicated (21 of 24 experts, 88%). CONCLUSION: Although treatment should always be adjusted to the specific patient, the results of this study may serve as general guidelines. Copyright

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