Impact of Pre-Interventional Observational Management Duration on Outcomes of Embolization for Splenic Injuries: Experience from Two Centers

To evaluate the clinical and technical success of splenic artery embolization (SAE) in the management of splenic trauma and factors affecting treatment outcomes. A retrospective and prospective study was conducted at two centers from December 2019 to December 2023, including 400 patients with splenic trauma (grade III-V according to the American Association for the Surgery of Trauma (AAST) - 2018 classification) and the Abbreviated Injury Scale (AIS) 2005 change from the AIS-1998. Factors affecting the effectiveness of embolization were determined by logistic regression analysis with p < 0.05 considered statistically significant. Technical success in SAE means successfully accessing the artery, deploying the embolic agent, and stopping blood flow to the injury site on angiography. Clinical success was defined as patient survival until discharge, absence of bleeding symptoms, and spleen preservation. Of the 400 patients, 262 were nonoperative management with observation (NOM-obs), 110 were splenic artery embolization (SAE), and 28 were surgical management (SM). The splenic preservation efficacy of SAE and NOM-obs was 98.2% and 97.7%, respectively (p > 0.05). Cranial Abbreviated Injury Scale (AIS) score ≥ 3 (OR: 0.104; 95% CI: 0.013-0.882; p = 0.032) and time from admission to embolization (OR: 0.953; 95% CI: 0.930-0.976; p < 0.001) were significant factors affecting the efficacy of embolization. There was no association between age, gender, mechanism of injury, and splenic injury severity with the embolization's effectiveness. Higher cranial AIS Score (OR, 1.633; 95% CI: 0.956-2.788; p = 0.043), more need for red blood cell transfusion (OR, 1.112; 95% CI: 0.998-1.134; P = 0.006), were associated with higher rates of treatment with SM compared with SAE for splenic injury. For other variables, faster heart rate (OR, 1.372; 95% CI: 0.950-1.994; P = 0.013), slightly higher red blood cells transfusion requirement (OR, 1.321; 95% CI: 1.000-1.435; P = 0.042), lower Hemoglobin (OR, 0.803; 95% CI: 0.722-1.190; P = 0.012), and lower hematocrit (OR, 0.676; 95% CI: 0.518-0.882; P = 0.004) were all associated with higher odds of SAE treatment compared with NOM-obs for splenic injury. SAE is a safe and effective method for managing grade III-V splenic injuries, demonstrating high rates of splenic preservation. Notably, the timing of the embolization plays a critical role in treatment outcomes; earlier intervention from hospital admission to embolization significantly correlates with improved success rates. Prompt action in performing embolization is essential for optimizing patient outcomes.