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...
Interactive Decision Tree
Algorithm Steps
- ▶Start
Blunt Splenic Injury
CT-confirmed splenic injury
- ●Action
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
- ◆Decision
Hemodynamic Status?
Assess stability for NOM
- ⚠Warning
Unstable → Splenectomy
Operative management
- Hemodynamically unstable despite resuscitation
- Exploratory laparotomy
- Splenectomy (damage control)
- Splenic salvage rarely possible when unstable
- ●Action
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
- ✓Outcome
Splenic Injury Managed
Recovery and follow-up
- ◆Decision
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
- ◆Decision
Contrast Blush on CT?
Active extravasation
- ●Action
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
- ◆Decision
NOM Successful?
Monitor for failure
- Failure signs:
- • Hemodynamic instability
- • Falling hematocrit requiring transfusion
- • Peritonitis
- • >4 units pRBC in 48h (relative)
- ⚠Warning
NOM Failure → OR
Delayed splenectomy
- Operative exploration
- Usually splenectomy
- Splenorrhaphy if stable and feasible
- Consider partial splenectomy
- ●Action
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
- ●Action
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
Guideline Source
WTA Critical Decisions: Blunt Splenic Injury 2023
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
Next steps
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Related Resources
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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