Comparison of outcomes before and after establishing a regional trauma center and following a protocol to treat blunt splenic injury in South Korea: A retrospective study

Abstract

Background: Nonoperative management for hemodynamically stable splenic injury has been accepted as appropriate treatment. Objectives: This study aimed to investigate the changes in management and clinical outcomes of splenic injury by introducing a protocol for splenic injury at a newly established regional trauma center. Methods: From January 2005 to December 2016, we reviewed the outcomes of all 257 patients who sustained blunt trauma to the spleen at the first regional trauma center in South Korea. This 11-year period was divided into two intervals, before 1 January 2014 (period I, n=189 patients) and after 1 January 2014 (period II, n=68 patients), when the trauma center was established and a formal management protocol was followed for patients with blunt traumatic splenic injuries. Results: The proportion of emergency operations performed for patients with more serious (grades 3-5) splenic injuries was lower in period II than in period I (29% vs 22%, respectively, p<0.001) whereas the rate of angioembolization was higher (89% vs 39.0%, respectively, p<0.001). The time to intervention, irrespective of whether emergency operation or angioembolization was performed, was shorter in period II than in period I (312.8 min vs 129 min, respectively, p=0.001). A greater proportion of patients was managed non-operatively in period II (78% vs 71%), and the non-operative management success rate was higher in period II than it was in period I (100% vs 83%; p=0.014). Similarly, the splenic salvage rate was higher in period II (78% vs 59%, p=0.03). Conclusion: After establishing a regional trauma center and introducing a protocol for the management of blunt splenic injuries, the rates of non-operative management and splenic salvage improved significantly. The reasons for this may be multifactorial, being related to the early involvement of a trauma surgeon, expansion of angiographic facilities and resources, and the introduction and application of a protocol for managing blunt splenic injury.