Angiographic Evaluation and Intervention for Traumatic Solid Organ Injuries

 VBMC TRAUMA CARE SERVICES GUIDELINE

 

TITLE: Angiographic Evaluation and Intervention for Traumatic Solid Organ Injuries

PURPOSE:

Over the past twenty years there has been a shift towards non-operative management (NOM) for hemodynamically stable patients with abdominal trauma. Angiographic embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the

indications for NOM in the management of solid organ injury. These improvements mean that whilst surgery is still usually recommended for patients with penetrating injuries, multiple bleeding sites or hemodynamic instability, the indications for NOM and angiographic evaluation and embolization are expanding.

 

GUIDELINE:

Patients who are hemodynamically unstable or who have diffuse peritonitis after blunt abdominal trauma should be taken urgently for laparotomy.

In the hemodynamically stable blunt abdominal trauma patient without peritonitis, an abdominal CT scan with intravenous contrast should be performed.

Solid Organ Injuries should be graded according to the AAST solid organ injury Grading Scale:



Angiography with embolization may be considered as a first-line intervention for a patient who is a transient responder to resuscitation as an adjunct to potential operative intervention in patients with Grade III or greater solid organ injuries.

 

Angiography with embolization should be considered in a hemodynamically stable patient with evidence of active extravasation (a contrast blush) on abdominal CT scan.

 

RESOURCES/REFERENCES:

Blunt Splenic Injury, Selective Nonoperative Management of. (n.d.). Retrieved July 07, 2017, from https://www.east.org/education/practice-management-guidelines/blunt-splenic-injury,-selective-nonoperative-management-of