[Skip to Content]
[Skip to Content Landing]
Views 389
Citations 0
Invited Commentary
September 16, 2020

How Should the SPLASH Trial Inform the Care of Patients With Blunt Splenic Trauma?

Author Affiliations
  • 1Division of Acute Care Surgery, McGovern Medical School at University of Texas Health Science Center at Houston
JAMA Surg. Published online September 16, 2020. doi:10.1001/jamasurg.2020.3687

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.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×