USEFUL CLASSIFICATION OF CT FINDINGS WHEN DECIDING ON THE INITIAL TREATMENT STRATEGY FOR BLUNT SPLENIC TRAUMA

Abstract

　　This retrospective study, including 36 patients with blunt splenic injuries, evaluated whether our classification based on the computed tomography (CT) findings was useful in determining the optimal initial treatment strategy for splenic injury. We defined the CT grading system as follows : Grade 1, splenic injury without extravasation ; Grade 2, with extravasation confined within the splenic parenchyma ; Grade 3, with extravasation that extended into the peritoneal cavity and with a poor-enhancement region in a segment of the parenchyma ; and Grade 4, with extravasation that extended into the peritoneal cavity and with a diffuse poor-enhancement region in the parenchyma. The proportions of CT grades stratified for the different treatment strategies were as follows : conservative treatment : Grade 1, 0% ; Grade 2, 18% ; Grade 3/4, 0% ; trans-catheter arterial embolization (TAE) : Grade 1, 0% ; Grade 2, 11% ; Grade 3, 89% ; Grade 4, 0% ; and laparotomy : Grade 1/2, 0% ; Grade 3, 60% ; Grade 4, 40% (p<0.01). The sensitivity and specificity of a classification higher than Grade 2 for the need for hemostasis were 93% and 100%, respectively. Our findings suggest that this CT grading system would be helpful for determining the optimal initial treatment strategy for blunt splenic trauma.