• AJR Am J Roentgenol · Dec 2007

    Comparative Study Controlled Clinical Trial

    Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems.

    • Helen Marmery, Kathirkamanthan Shanmuganathan, Melvin T Alexander, and Stuart E Mirvis.
    • Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 S Greene St., Baltimore, MD 21201, USA.
    • AJR Am J Roentgenol. 2007 Dec 1;189(6):1421-7.

    ObjectiveThe purpose of this study was to compare the usefulness of two CT grading systems of blunt splenic trauma in predicting which patients need surgery or angioembolization.Materials And MethodsFour hundred patients in hemodynamically stable condition admitted with blunt splenic injury were included in the study. All patients underwent contrast-enhanced MDCT. Grade of splenic injury was prospectively assigned according to the American Association for the Surgery of Trauma (AAST) splenic injury scale. Patients were treated with surgical intervention, splenic arteriography with or without embolization, or observation alone. All MDCT images were retrospectively reviewed and regraded according to a novel grading system that specifically incorporates the findings of active bleeding or splenic vascular injury, including pseudoaneurysm and arteriovenous fistula. Receiver operating characteristics curves were generated with both grading systems for all splenic interventions, and statistical analyses were performed.ResultsThe area under the ROC curves for the new splenic grading system for splenic arteriography, surgery, and both interventions exceeded 80%. The area under the curve for the new splenic grading system was greater than that for the AAST injury scale for all interventions. Differences were found to be statistically significant for splenic arteriography (p = 0.0036) and the combination of arteriography and surgery (p = 0.0006).ConclusionThe proposed CT grading system is better than the AAST system for predicting which patients with blunt splenic trauma need arteriography or splenic intervention.

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