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Splenic Injury Prospective Outcomes Trial

Principal Investigator: Ben Zarzaur, MD
Lead Institution:  University of Tennessee at Memphis
Participating Sites:  University of California at San Diego, University of Texas Health Science Center San Antonio, University of Pittsburgh-Mercy Hospital, University of Pittsburgh-Presbyterian Hospital, University of Texas Health Science Center at Houston, University of Florida Health Science Center at Jacksonville, Yale School of Medicine, Case Western Reserve, Adams Cowley Shock Trauma Center, Medical College of Wisconsin

Nearly 39,000 adults will suffer a blunt splenic injury (BSI) this year from incidents such as car crashes and falls. Current guidelines suggest that if a patient with a BSI has a good heart rate and good blood pressure, he or she does not have to go immediately to the operating room to have the spleen removed. However, over 10% of patients managed this way will have to undergo spleen removal within five days of injury because the spleen will begin to severely bleed. The greater risk, though, may be to patients who are discharged from the hospital after only a few days. These patients may suffer sudden spleen rupture in the outpatient setting. The six-month risk of spleen removal after discharge with BSI is thought to be less than 2%. But the exact rate is not known because no one has tried to follow patients with BSI for a full six months after injury to determine what will happen. This research will follow 1,000 patients with BSI from 11 trauma centers across the country for six months. By doing this, researchers will obtain an accurate estimate of the six-month risk of spleen rupture after BSI. The researchers will also be able to determine factors associated with delayed splenic rupture and be able to determine which of the several treatments are best for patients with a BSI. This research will be significant because it is expected to lead to the development of strategies that will result in subjecting adults with BSI to the least risk while preserving the most spleens.

Publications

Zarzaur, BL., Kozar, R, Myers, JG, Claridge, JA, Scalea, TM, Neideen, TA, Maung, AA, Alarcon, L, Corcos, A, Kerwin, A, Coimbra, R. “The splenic injury outcomes trial: An American Association for the Surgery of Trauma multi-institutional study.” J Trauma Acute Care Surg. 2015:79(3): 335-342.
DOI: 10.1097/TA.0000000000000782

Zarzaur BL, Rozycki GS. An update on nonoperative management of the spleen in adults. Trauma Surgery & Acute Care Open. 2017;2(1). DOI:10.1136/tsaco-2017-000075