Management of blunt splenic injury has evolved over time, with nonoperative management being the recommended initial management strategy among hemodynamically stable adult patients without peritonitis.1 Although advances have resulted in the improved success of nonoperative management and in the identification of patients at high risk for splenic failure, questions remain regarding the optimal role of angioembolization for these patients.2 In this issue of JAMA Surgery, Arvieux et al3 randomized 140 patients with grade 3 or higher blunt splenic injuries to prophylactic splenic angioembolization or surveillance with as-needed angioembolization in the study for Splenic Arterial Embolization to Avoid Splenectomy (SPLASH) trial. Overall, 96% patients had a viable spleen at 1 month, with no difference in splenic preservation between the 2 groups. Approximately one-third of patients in the surveillance group required either splenectomy or embolization, with the only risk factor for splenic failure being the severity of the splenic injury. The surveillance group experienced significantly more pseudoaneurysms and a longer median length of stay than the prophylactic splenic angioembolization group. There were no differences in patient-reported outcomes of functional activity and time off work or studies.
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Dodwad S, Wandling MW, Kao LS. How Should the SPLASH Trial Inform the Care of Patients With Blunt Splenic Trauma? JAMA Surg. Published online September 16, 2020. doi:10.1001/jamasurg.2020.3687
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