Angioembolization Drives Overall Increase in Rates of Intervention in Children with Blunt Liver and Spleen Injuries
*Nicholas Yung, Daniel Solomon, Emily Christison-Lagay
Yale University, New Haven, CT
Objective: To evaluate the effect of angioembolization on overall intervention rates in children admitted for blunt spleen and liver injuries to differential trauma centers. Design: Retrospective cohort study. Setting: Data was extracted from National Trauma Data Bank (NTDB) pertaining to level I and II ACS verified Adult (ATC), Dual (DTC), and Pediatric (PTC) centers. Patients or Other Participants: Children age less than 19 years old with isolated blunt liver or spleen injuries from 2007-2016. Patients treated at level I and II ACS verified centers were included. Isolated blunt injuries to spleen (n=15,737) and liver (n=15,460) were identified. Interventions: Angiographic procedures (angiograms and angioembolizations) and surgical interventions (splenectomies and exploratory laparotomies). Main Outcome Measures: Rates of angiographic, open, and overall procedures. Results: Open intervention rates at ATCs have decreased -0.3%/year (p=0.011) over the last decade. However, their open intervention rate in 2016 of 15.92% far exceeds PTCs (p=0.001), whose intervention rate of 4.71% has been consistent over the last decade (p=0.58). Rates of angiography at ATCs (+0.6%/year (p<0.001) with an overall rate of 7.8% in 2016) exceeded the reductions in open interventions. ATCs have therefore seen an increase of 0.3%/year in overall interventions to a 2016 rate of 21.9% (p=0.02), while rates for PTCs have remained static (p=0.58). Conclusion: While the care of blunt liver and spleen injuries at PTCs approach APSA benchmarks for non-operative intervention (3% for isolated splenic injury), ATCs continue to have operative rates 3-5 fold higher than those benchmarks. Overall intervention in the children has increased. This suggests that embolization is used not only as a substitute for operative intervention but increasingly to treat children who previously might have been managed non-operatively.
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