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Blunt Splenic Injury Management (WTA 2023)

Blunt Splenic Injury Management (WTA 2023): Blunt Splenic Injury → AAST Injury Grade → Hemodynamic Status? → Unstable → Splenectomy → Post-Splenectomy C...

Pathway Overview

13 steps

Algorithm Steps

13 total

  1. 01Start

    Blunt Splenic Injury

    CT-confirmed splenic injury

  2. 02Action

    AAST Injury Grade

    Grade on CT findings

    • Grade I: Subcapsular hematoma <10%, laceration <1cm
    • Grade II: Subcapsular 10-50%, laceration 1-3cm
    • Grade III: Subcapsular >50%, laceration >3cm, intraparenchymal >5cm
    • Grade IV: Laceration involving segmental vessels, devascularization >25%
    • Grade V: Shattered spleen, hilar injury
  3. 03Decision

    Hemodynamic Status?

    Assess stability for NOM

  4. 04Warning

    Unstable → Splenectomy

    Operative management

    • Hemodynamically unstable despite resuscitation
    • Exploratory laparotomy
    • Splenectomy (damage control)
    • Splenic salvage rarely possible when unstable
  5. 05Action

    Post-Splenectomy Care

    OPSI prophylaxis

    • Vaccinate 14 days post-op (or before discharge):
    • • Pneumococcal (PCV13 then PPSV23)
    • • Meningococcal (MenACWY + MenB)
    • • Haemophilus influenzae type B
    • Patient education on asplenia risks
    • Medic alert bracelet
  6. 06Outcome

    Splenic Injury Managed

    Recovery and follow-up

  7. 07Decision

    Stable: NOM Candidate?

    Assess for non-operative management

    • NOM Criteria:
    • • Hemodynamically stable
    • • No peritonitis
    • • No other indication for laparotomy
    • • ICU monitoring available
    • • Transfusion threshold met
  8. 08Decision

    Contrast Blush on CT?

    Active extravasation

  9. 09Action

    Angioembolization

    For active bleeding or high-grade

    • Contrast blush on CT
    • Grade III-V injuries
    • Large hemoperitoneum
    • Proximal or selective embolization
    • Follow with ICU monitoring
  10. 10Decision

    NOM Successful?

    Monitor for failure

    • Failure signs:
    • • Hemodynamic instability
    • • Falling hematocrit requiring transfusion
    • • Peritonitis
    • • >4 units pRBC in 48h (relative)
  11. 11Warning

    NOM Failure → OR

    Delayed splenectomy

    • Operative exploration
    • Usually splenectomy
    • Splenorrhaphy if stable and feasible
    • Consider partial splenectomy
  12. Path rejoins step 05Shared downstream outcome
  13. 12Action

    Discharge Planning

    NOM success

    • Activity restrictions (grade-dependent):
    • Grade I-II: 3-4 weeks
    • Grade III: 6 weeks
    • Grade IV-V: 3 months
    • Avoid contact sports, heavy lifting
    • Follow-up imaging controversial
    • Return precautions for LUQ pain
  14. Path rejoins step 06Shared downstream outcome
  15. 13Action

    Observation Only

    Low-grade, no blush

    • Grade I-II without blush
    • Serial abdominal exams
    • Serial hematocrits q6h
    • Bed rest, activity restriction
    • Repeat imaging if deteriorates
  16. Path rejoins step 10Shared downstream outcome
  17. Path rejoins step 04Shared downstream outcome

Guideline Source

WTA Critical Decisions: Blunt Splenic Injury 2023

DOI: 10.1097/TA.0000000000003877View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Requires ICU monitoring capability for NOM
  • Angioembolization availability varies
  • Delayed splenic rupture risk with NOM
  • Post-splenectomy vaccination protocol essential

Applicable Regions

USEUGlobal
Version 1Next review: 2027-01-01

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Frequently Asked Questions

What is the Blunt Splenic Injury Management (WTA 2023)?

The Blunt Splenic Injury Management (WTA 2023) is a management clinical algorithm for Trauma Surgery. It provides a structured decision tree to guide clinical decision-making, based on WTA Critical Decisions: Blunt Splenic Injury 2023.

What guideline is the Blunt Splenic Injury Management (WTA 2023) based on?

This algorithm is based on WTA Critical Decisions: Blunt Splenic Injury 2023 (DOI: 10.1097/TA.0000000000003877).

What are the limitations of the Blunt Splenic Injury Management (WTA 2023)?

Known limitations include: Requires ICU monitoring capability for NOM; Angioembolization availability varies; Delayed splenic rupture risk with NOM; Post-splenectomy vaccination protocol essential. Individual patient factors may require deviation from these recommendations.

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