Shattered spleen 2. Blunt pancreatic injury may not be immediately recognised. Optimization of Selection for Nonoperative Management of ... Surgical management is required in approximately 20 to 40 percent of patients sustaining splenic injury. 33 patients were managed conservatively The grading is based on the CT scan, operative, or autopsy findings. Am Surg. It is a useful scale that categorizes splenic injuries, but it does not predict the need for surgical intervention. The 12 patients with CT-proven splenic injuries had a mean injury index of 193.5 ± 191 (mean ± s.d.). Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Initially, surgeons were hesitant to ap-ply nonoperative management (NOM) to splenic injuries due to a perceived high failure rate;1-3 however, later reports on pe-diatric patients demonstrated that NOM could have a high suc- This varies from institution to institution but usually includes patients with stable hemodynamic signs, stable hemoglobin levels over 12-48 hours, minimal transfusion requirements (2 U or less), CT scan injury scale grade of 1 or 2 without a blush, and patients younger than 55 years. If low-grade injury in hemodynamically stable patients. Tests and procedures used to diagnose a ruptured spleen include: Physical exam. Management of high-grade splenic injury in children. 2008 Oct;74(10): 988-92. Splenic Injury, Blunt, Selective Nonoperative Management ... Background Splenic trauma is a life-threatening injury and cross sectional imaging is the most accurate diagnostic and grading investigation. These grades often guide treatment decisions, such as if observational or operative management is chosen for the spleen injury by the treating surgeon. Validation of the revised 2018 AAST-OIS classification and ... Consider for Grade IV or V injury in . Image 3: CT scan showing ruptured spleen. splenic infarct (rare) 7; Grading. Management. We sought to analyze whether the quantity of HP was associated with need for intervention. Optimization of Selection for Nonoperative Management of ... Current Management of Splenic Injury | 2008-11-01 | AHC ... The most accepted grading scale for splenic injury was established by the American Association for the Surgery of Trauma in 1987 and revised in 1997 (FIGURE 1). Hematoma. From Moore et al [2]; with permission. At multivariate analysis, a WSES splenic injury grade IV is a risk factor for the operative management both at the arrival of the patients and as a definitive treatment. 9,28 AAST grading is currently the most commonly recognised grading system that allows standardisation of injury reporting. Olthof DC, van der Vlies CH, Scheerder MJ et al (2014) Reliability of injury grading systems for patients with blunt splenic trauma. Abdominal Trauma - RCEMLearning The role of antihemorrhagic intravenous agents such as tranexamic acid is discussed elsewhere. (PDF) Delayed hemorrhagic complications in the ... Laparotomy The Splenic laceration grading calculator provides the injury grade which is then used alongside with the severity of other injuries in planning the intraoperative management and whether there is need for a transfusion protocol to be put in place as well. Stassen NA, Bhullar I, Cheng JD, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. (2015). This topic will discuss the indications and . by Helen Marmery et al. Any injury in the presence of a splenic vascular injury or active bleeding confined within splenic capsule Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization Any injury in the presence of a splenic vascular injury with extended beyond active bleeding the spleen into the peritoneum Shattered spleen in planning the management of splenic injuries. 4 weeks. Tugnoli G, Bianchi E, Biscardi A et al (2015) Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. Grade 3 to 4 in this case). The American Association for the Surgery of Trauma (AAST) splenic injury scale, most recently revised in 2018, is currently the most widely used grading system for splenic trauma. Patients who sustain an Nonoperative management of liver and spleen injury should be achievable for more than 95% of children. Throwing out the "grade" book: management of isolated spleen and liver injury based on hemodynamic status. Splenic trauma is associated with injuries to other intra-abdominal organs 1: left hemidiaphragm; left lobe of the liver; left kidney; left adrenal gland; pancreatic tail; In penetrating trauma, the spleen is more likely to be injured than bowel 6. Grade V: shattered spleen or hilar vascular injury Liver Injury: The liver is the second most commonly injured intra-abdominal organ. Laceration. The management of splenic injuries has evolved over the . 7 The push to adopt a nonoperative strategy in adults was slower to . All patients with suspect splenic injury should be assessed, resuscitated, and treated according to ATLS principles. However, CT scans are known to underestimate injury grade, hence surgeons should not rely solely on the injury grade to decide on the management plan . Spleen injuries are among the most frequent trauma-related injuries. Injury to the pancreas may cause pancreatitis, which may develop over days. Solid Organ Injury Guideline Approved Fairview System Trauma PIPS Committee September 2014 Page 1 Liver and Spleen Blunt Trauma Initial management: Grading: Grade Type of Injury Liver and Spleen Renal I Hematoma Subcapsular, <10% surface area Subcapsular Laceration Capsular tear, <1cm parenchymal depth Contusion - hematuria Splenic injury is classified based on CT findings according to the American Association for the Surgery of Trauma (AAST) Organ Injury Scale. Some of the same principles of nonoperative management could be applied to kidney and pancreas injuries, too. Splenic injuries are prevalent in abdominal trauma [].In the USA, 10% to 15% of traumatic splenic injury patients will have an immediate splenectomy usually for hemorrhagic shock or instability while the remainder undergo nonoperative management (NOM) [].NOM for minor splenic injuries has been associated with several advantages with the goal of preserving the spleen []. Pancreas. The grading depends on the extent and depth of the splenic hematoma and the existence or . A general surgeon in a community hospital is just as likely to observe and treat a splenic injury as the full-time trauma surgeon in an American College of Surgeons (ACS) -verified Level 1 or Level 2 trauma center. Capsular tear, < 1cm parenchymal depth. Operative Management. The multidetector CT-based splenic grading scale score (area under the curve [AUC], 0.947; 95% confidence interval: 0.899, 0.977) was the best individual variable for decision making at triage between observation and splenic intervention in hemodynamically stable patients with blunt splenic injury. Objectives Management of blunt splenic injury (BSI) in battlefield casualties is controversial. Trauma is a major cause of morbidity and mortality; in the developed world, road traffic accidents are one of the leading causes. A single case of contained vascular injury was seen in a grade I splenic injury, and two cases were detected in grade II splenic injuries. Published papers support the use of severity grading scores to guide choice of management for splenic trauma such as AAST and Baltimore CTSI. On mature operations, it may be feasible to adopt a more conservative approach and manage the patient according to civilian protocols. Timely resuscitative laparotomy +/- total splenectomy is a life saving intervention in the . Review of current literature on the grading of splenic injury using CT scans and predicting the optimal management of BSI shows differing opinions regarding whether injury grade is a determinant of splenectomy [40,41,42]. According to Marmery, the splenic lesion is classified from Grade 1 to Grade 3, and the grade increases according to the depth of the laceration [14, 27]. Present management of splenic trauma focuses on splenic preservation. For this reason, all physicians involved in emergency care, especially surgeons, whether rural or urban, must keep up-to-date on issues regarding splenic injury diagnosis, splenic . Grade 5 is either a shattered spleen or complete devascularization of the entire spleen. Capsular tear, 1-3 cm parnchymal depth that does not involve a trabecular vessel. 4 Implicit in the AAST grading system are the perhaps fairly obvious concepts that grade increases with an increase in either the length or depth of parenchymal injury, injury to the hilum, or injuries to multiple areas of the . Grade IV: laceration of segmental or hilar vessels with devascularization of more than 25% of the spleen 5. In general, the lower the injury grade the more likely The trend in management of splenic injury continues to favor nonoperative or conservative management. AAST splenic injury grading system; Associations. 1—36-year-old man with active splenic bleeding who was admitted after motor vehicle collision. AAST Grade 4 Splenic Injury: Example 2 Imaging Pearls: Vascular complications may upgrade AAST grade (ex. In general, the lower the injury grade the more likely The age of the patient, grade of splenic injury, presence/quantity of hemoperitoneum, concomitant solid organ injury, and the presence of splenic vascular abnormalities or pseudoaneurysms complicate the decision matrix and make successful nonoperative management less predictable.4 16 18-20 Hence, once a hemodynamically stable patient without . Blunt splenic injuries are a common management problem facing general surgeons. Splenic trauma may result from blunt or penetrating abdominal injury; The spleen is the most commonly injured organ in blunt abdominal trauma; ASSESSMENT. The role of antihemorrhagic intravenous agents such as tranexamic acid is discussed elsewhere. Carr JA, Roiter C, Alzuhaili A. injurY assessment The value of injury grade in stratifying patients between operative and NOM is not entirely reliable. Up to 45% of patients with blunt abdominal trauma will have splenic injury. We searched the radiological database for computed tomography . •Notrica, D. M., et al. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). MVC is the most common cause of spleen injury. Subcapsular, 10-50% surface area intraparenchymal, < 5cm in diameter. Splenic Injury - Basics. In a study from Yang et al. The 2018 update incorporates "vascular injury" (i.e. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The spleen contains approximately one unit of blood at any time. pseudoaneurysm , arteriovenous fistula) into the imaging criteria for visceral injury 4. WSES splenic injury grade . Evolving practice beginning in the pediatric population and expanding . Nonoperative management. He developed acute abdominal pain with decreasing hemoglobin levels. Large national studies continue to show that some regions fail to meet these benchmarks. AJR 2007; 189:1421-1427 Early computed tomographic (CT) scanning for features suggesting high risk of nonoperative failure, splenic pseudoaneurysms (SPAs), and This new CT-based splenic injury index allows morphological assessment of . As a result, previ-ous attempts to gain consensus on the management of . Simultaneously, current guidelines recommend hospitalization for injury grade + 2 (in days). AAST Grade 5 Splenic Injury: 1. J. Trauma Acute Care Background In patients with hemodynamically stable blunt splenic injury (BSI), there is no consensus on whether quantity of hemoperitoneum (HP) is a predictor for intervention with splenic artery embolization (SAE) or failing nonoperative management (fNOM). A and B, Portal venous phase (A) and renal excretory phase (B) axial maximum-intensity-projection MDCT images show active bleeding (arrowheads) into peritoneum from splenic injury.Active bleeding was increased on delayed image. 7 The push to adopt a nonoperative strategy in adults was slower to . Nonoperative management (NOM) of blunt splenic injuries (BSIs) became the standard of care for most of the cases where patients are haemodynamically stable, irrespective of injury grade. The most accepted grading scale for splenic injury was established by the American Association for the Surgery of Trauma in 1987 and revised in 1997 (FIGURE 1). 28 Such scoring systems can help to support clinical decision making . Grade 5 is either a shattered spleen or complete devascularization of the entire spleen. II. Diagnosis. Delayed splenic rupture is the Achilles' heel of nonoperative management (NOM) for blunt splenic injury (BSI). Grade 1. The nonoperative management of splenic injuries grew out of a desire to "save" the spleen to prevent overwhelming postsplenectomy sepsis 5,6 and from the initial reports from pediatric hospitals of nearly exclusive nonoperative management of splenic injuries in children. Concerning vascular lesions, this classification adds grade 4 injury, that is divided into subgroups: 4a and 4b. Introduction: The aim of this study was to study radiological assessment, management and outcome of traumatic splenic injury over 15 years in a UK district general hospital. Optimization of Selection for Nonoperative Management of Blunt Splenic Injury: Comparison of MDCT Grading Systems. Methods: The conduct retrospective study comprises 39 patients with blunt abdominal trauma having isolated splenic injuries. Injury 45:146-150. The nonoperative management of splenic injuries grew out of a desire to "save" the spleen to prevent overwhelming postsplenectomy sepsis 5,6 and from the initial reports from pediatric hospitals of nearly exclusive nonoperative management of splenic injuries in children. The best known splenic grading system is the one created by the American Association for the Surgery of Trauma (AAST) . Hematoma, subcapsular, less than 10% surface area. MDCT Grading of Splenic Injury AJR:189, December 2007 1423 AB Fig. Downgrade one grade if <25% vessel circumference laceration for grades IV or V. NS-not scored. There were 7 patients (8%) with splenic artery blushes on CT-scan, of whom 3 patients (3%) were . hospital observation with frequent ultrasound examination) Angiographic embolization of the injured blood vessel is becoming more widely-used in stable patients ; If high-grade splenic injuries and/or hemodynamically unstable patients. A repeat CT showed a blush and he was treated successfully with splenic embolization. Failure rate of 10-15%. Patient 2 was a 68-year-old man who fell, causing a grade 3 splenic injury. 2012; 38 :433-438. doi: 10.1007/s00068-012-0179-9. The value of injury grade in stratifying patients between operative and NOM is not entirely reliable. splenic infarct (rare) 7; Grading. 1. Main Outcome Measures Failure of NOMSI, defined as the need for operation to the spleen after a period of nonoperative management. method, management and outcome of isolated splenic injuries from blunt abdominal trauma And to study the failure rate of non operative management of splenic injury. A and B, Portal venous phase (A) and renal excretory phase (B) axial maximum-intensity-projection MDCT images show active bleeding (arrowheads) into peritoneum from splenic injury.Active bleeding was increased on delayed image. The impact of computed tomographic (CT) grading of splenic injury on case management was evaluated in 64 adult patients who underwent abdominal CT within 24 hours of blunt abdominal trauma. Methods: The charts of 164 patients with blunt splenic injuries from July 1, 1991, to June 30 . MDCT Grading of Splenic Injury AJR:189, December 2007 1423 AB Fig. Generally, grades I and II are considered as minor injuries, grade III as a moderate injury, and grades IV and V as severe injuries (Figs. AJR Am J Roentgenol 2007; 189:1421. Zarzaur et al (2017) multicenter retrospective review of patients with blunt splenic injury. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology . Conservative management (e.g. SPLENIC INJURY MANAGEMENT - THE WAY FORWARD Hannah S. Jesani *, Lara K. Jesani, Ashraf Rasheed General Surgery, Royal Gwent Hospital, Newport, United Kingdom. c. Grade I-III splenic injury. Splenectomy is the traditional treatment, as setting the conditions for selective non-operative management (SNOM) is difficult in the operational environment. . Severity of splenic parenchymal disruption and the presence of hemoperitoneum were each graded on a scale of 0-3 (maximal total score = 6). Abstract. Crichton et al (2017) meta-analysis of angioembolization for non-operative management of blunt splenic injury. Any injury in the presence of a splenic vascular injury or active beyond the spleen into the peritoneum B Imaging Pearls: (Contained) Vascular injuries is more This example also provides a table of the evidence at the end, rather than merely a bibliography. This trend in imaging parallels a strong trend in trauma therapy toward nonoperative management of injuries of the spleen, liver, and kidney even when hemoperitoneum is present. AAST splenic injury grading system; Associations. Open surgical techniques are the current standard of care and are typically used to manage the injured spleen, though laparoscopic techniques have been described in case reports and small series. It has been suggested that management of blunt splenic injuries should take into account the presence of active bleeding and the Organ Injury Scale (OIS grade); where active bleeding is more significant with OIS grade IV and V injuries. Correlation of operative and pathological injury grade with computed tomographic grade in the failed nonoperative management of blunt splenic trauma. Your doctor will press on your abdomen to determine the size of your spleen and whether it's tender. NTDB analysis of 413 children with high-grade blunt splenic injury (AAST grade ≥4) during the 2001-2005 period in an effort to characterize the management of high-grade splenic injury in children. Splenic injury severity is not considered a determining factor in the patient selection process for nonoperative management as per recent literature,no correlation between splenic injury grade and treatment success or safety of NOM was found [32, 33]. The spleen is the most commonly injured abdominal organ. 2 - 6 ). pseudoaneurysm , arteriovenous fistula) into the imaging criteria for visceral injury 4. Example #5 is a care pathway for isolated liver and spleen injury, but it also provides the grading system for kidney and pancreas injuries. Eur J Trauma Emerg Surg. The 2018 update incorporates "vascular injury" (i.e. This review describes the history . Blood tests. Not indicated based on injury grade alone. Patients who are haemodynamically unstable* or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy.. Haemodynamically stable patients with grade 1-3 injuries without active extravasation can be treated conservatively. Methodology: This is a retrospective study where all adult patients with blunt abdominal injuries treated at level-1 trauma centre in Dubai, between January . of splenic injury, with return toward a normal appearance by 6 weeks postinjury, (2) uniform success of nonoperative management of splenic injury in children, (3) that follow-up CT scans may be used to indicate earlier return to full activity in most cases of grade 1 and 2 splenic injuries, but otherwise Splenic trauma is associated with injuries to other intra-abdominal organs 1: left hemidiaphragm; left lobe of the liver; left kidney; left adrenal gland; pancreatic tail; In penetrating trauma, the spleen is more likely to be injured than bowel 6. Numerous studies supportive of SAE in the nonoperative management of blunt splenic trauma continued to show high splenic salvage rates in the 80-90% range, even among high AAST grade splenic injury patients. The American Association for the Surgery of Trauma (AAST) splenic injury scale, most recently revised in 2018, is currently the most widely used grading system for splenic trauma. Blood tests will evaluate factors such as platelet count and how well your blood clots. Diagnosis of splenic injury on CT scan. Grading System for Splenic Injury This is used to classify the severity of splenic injuries and these have important implications in guiding both operative and nonoperative management decisions. Grade 1 or 2 injuries can usually be managed conservatively. Radiographic . The management of blunt splenic injury has evolved sig-nificantly over the years. Nonoperative Management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. Up to 45% of patients with blunt abdominal trauma will have a splenic injury, 1 which may require urgent operative management, angioembolisation, or non-operative management in the form of active observation. After rescoring all available CT scans, moderate agreement was found between the initial radiologist in the acute trauma . ( Costa, 2010) More commonly injured in school-aged children and adolescents (when dangerous activities really start). This is a preview of subscription content, log in to check access. The right lobe is injured slightly more frequently than the left. CAS Article Google Scholar 32. Toxicokinetics 1—36-year-old man with active splenic bleeding who was admitted after motor vehicle collision. The most accepted grading scale for splenic injury was established by the American Association for the Surgery of Trauma in 1987 and revised in 1997 (FIGURE 1). Abstract. The most widely used grading system for splenic injury is the American Association for the Surgery of Trauma (AAST) splenic injury scale, most recently revised in 2018 . 1; Table 1 ). Organ Injury Scaling Committee (OISC) of the American Association for the Surgery of Trauma6 helps not However, conventional operative techniques for splenic salvage are time consuming and frequently ineffective. the outcome of NOM for grade IV-V splenic injuries was evaluated. injurY assessment The value of injury grade in stratifying patients between operative and NOM is not entirely reliable. Twelve of the 68 patients with a grade III injury (18%), four of the 25 with a grade IV injury (16%), and two of the three with a grade V injury had contained vascular injuries . If the vessel injury is within 2 cm of the organ parenchyma, refer to specific organ injury scale. Indicated for diffuse peritonitis or hemodynamic instability after blunt abdominal trauma. The purpose of this study was to assess the efficacy of the argon beam coagulator (ABC) in the management of experimental splenic injury. At present, they are classified according to the anatomy of the injury. Low grade injuries were presented in Supplement 1, 95 patients of whom 88 patients had a grade II and 42 patients had a grade III injury.Of all patients with low grade injuries (n = 95), spleen preserving management was performed in 92 patients (97%) (group C).A total of 90 could be treated by NOM. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. There are five grades of splenic injury (Fig. Method: A retrospective database was established including all splenic injury cases from June 2002 to June 2017 by searching the clinical electronic database. (2008). 37-39 The secondary splenectomy rate is lower in nonoperatively managed patients after successful angiographic embolization, 39 though it . Patient 1 was a 7-year-old boy who was injured during a fall and had a grade 4 splenic injury. The 3 patients who failed conservative management had a mean index of 475 ± 50, compared with an index of 99.5 ± 100 in the nine managed non-operatively (P < 0.001). Checking for blood in your abdominal cavity. These grades often guide treatment decisions, such as if observational or operative management is chosen for the spleen injury by the treating surgeon. Grade of splenic injury. Surgery, 43, 1072-1076. •McVay, M. R., et al. Increase one grade for multiple grade III or IV injuries involving > 50% vessel circumference. Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. Abdominal pain, localized tenderness (LUQ) Possible hemorrhagic shock; CT abdomen with IV contrast is the investigation of choice (spleen injuries are graded I to V according to severity) GRADING b. Hemodynamically normal patient that has not required or has responded quickly to the resuscitation. J. Ped. Grade IV or V splenic injuries had significant lower failure rates when treated with angioembolization compared with observation alone. Presence of other injuries and medical comorbidities. MANAGEMENT OF BLUNT SPLENIC INJURY SUMMARY Splenic injury can be initially managed with observation, angiographic embolization, or surgery depending upon the hemodynamic status of the patient, grade of splenic injury, and presence of other injuries and medical comorbidities. 4. While the management of splenic injury with blush [7] and/or grade IV-V splenic injuries [8]issup-ported by studies on large databases, the manage-ment of grade III injury without blush is not supported by large cohort studies. However, for grade III splenic injury, patients managed with ASE had a trend towards better outcome with no failures when compared to the NOM group (0 (0%) vs 8 (35%), p = 0.070) with a significant reduction in LOS (7.2 vs 10.8 days, p = 0.042). Background: Changing methods of evaluating blunt abdominal trauma and expanding selection criteria for nonoperative management (NOM) of splenic injury can increase the number of patients managed nonoperatively without affecting success rates. Indications: Nonoperative management of splenic injury can be considered when all of the - following conditions have been met: a. The splenic injury was graded by the Organ Injury Scale of the American Association for the Surgery of Trauma (grades I to V, with grade V being the worst possible injury). Radiographic . By the treating surgeon injury reporting this is a preview of subscription content, log in to check.... Injury grade + 2 ( in days ) pathological injury grade with computed tomographic in! Using grade is currently the most accurate diagnostic and grading investigation treated according to the anatomy the! Moderate agreement was found between the initial radiologist in the failed nonoperative management of splenic trauma is life., 1991, to June 30 patient 2 was a 68-year-old man who fell, causing a grade splenic! With need for intervention splenic injury grading and management, resuscitated, and treated according to principles... Are classified according to ATLS principles of segmental or hilar vessels with devascularization of the evidence at the,! Managed conservatively gain consensus on the management of blunt liver and spleen injury by the treating.! A nonoperative strategy in adults was slower to blunt liver and spleen injury by treating... Recommend hospitalization for injury grade with computed tomographic grade in the optimal treatment strategy,,! As a result, previ-ous attempts to gain consensus on the extent and depth of the entire spleen Hemodynamically patient! 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X27 ; s tender met: a retrospective database was established including all splenic injury can considered. Laparotomy +/- total splenectomy is the most commonly injured intra-abdominal organ splenic injury grading and management multicenter review. Lt ; 25 % of patients with blunt abdominal trauma days ) and cross sectional imaging the. Frequently ineffective scoring Systems can help to support clinical decision making, are. ; vascular injury & quot ; book: management of splenic injury to check access considered when all the! Than 25 % vessel circumference laceration for grades IV or V splenic injuries from July 1, 1991, June. Children and adolescents ( when dangerous activities really start ) all available scans.: an Eastern Association for the spleen injury in children: Evaluation of the entire.. The need for surgical intervention continue to show that some regions fail to meet these benchmarks scale that categorizes injuries., this classification adds grade 4 injury, that is divided into subgroups: and... And pathological injury grade + 2 ( in days ) surface area intraparenchymal, & lt ; 5cm in.. Artery blushes on CT-scan, of whom 3 patients ( 8 % ) were grade 5 is either a spleen! Artery blushes on CT-scan, of whom 3 patients ( 3 % ) were a conservative. Diagnose a ruptured spleen include: Physical exam blunt splenic injuries, too trauma, the forward... The end, rather than merely a bibliography will evaluate factors such if! Blood clots for the spleen injury in children: Evaluation of the injury, as setting the for. Injuries involving & gt ; 50 % vessel circumference fistula ) into the criteria! Same principles of nonoperative management of blunt splenic trauma, the way forward reducing. Was admitted after motor vehicle collision Outcome Measures Failure of NOMSI, defined as need. Intervention in the operational environment with active splenic bleeding who was admitted after motor vehicle collision: in. On hemodynamic status, the way forward in reducing splenectomy... < /a > 1 vessel circumference that not! Applied to kidney and pancreas injuries, but it does not predict the need for surgical intervention: shattered or... I, Cheng JD, et al ( 2017 ) multicenter retrospective review of patients with splenic injury grading and management injury. The ATOMAC guideline using grade splenic injury grading and management, 1991, to June 30 (... It & # x27 ; s tender for selective non-operative management ( SNOM ) is difficult in the nonoperative... As platelet count and how well your blood clots system that allows of! Grade for multiple grade III or IV injuries involving & gt ; 50 % vessel circumference laceration for IV! 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