Radiology
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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. Severity of splenic parenchymal disruption and the presence of hemoperitoneum were each graded on a scale of 0-3 (maximal total score = 6). The splenic injury was graded retrospectively (stage 1) in 29 patients and prospectively (stage 2) in 35 patients. ⋯ In the latter group of patients, CT scoring did not change the operative rate (74% vs 75%) but did prompt earlier surgical intervention in stage 2. This significantly increased the rate at which spleen-saving operations were performed (from 21% to 67%, P less than .032) and the overall rate of splenic salvage. The CT scoring system used in this study appears to be a simple, reproducible, and useful method for quantitating splenic injury in blunt abdominal trauma.