Out with the old, in with the new? The revised AAST grading schema better predicts splenic salvage but not splenectomy.

Dhillon, Navpreet K; Harfouche, Melike N; DuBose, Joseph J; Kundi, Rishi; Kozar, Rosemary A; Scalea, Thomas M

Dhillon, Navpreet K; Harfouche, Melike N; DuBose, Joseph J; Kundi, Rishi; Kozar, Rosemary A; Scalea, Thomas M.

Afiliação

Dhillon NK; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA. Electronic address: N.Dhillon@ruhealth.org.
Harfouche MN; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA. Electronic address: mharfouche@som.umaryland.edu.
DuBose JJ; Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USA. Electronic address: jjd3c@yahoo.com.
Kundi R; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA. Electronic address: rkundi@som.umaryland.edu.
Kozar RA; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA. Electronic address: rkozar@som.umaryland.edu.
Scalea TM; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA. Electronic address: tscalea@som.umaryland.edu.

Am J Surg ; : 115800, 2024 Jun 13.

Article em En | MEDLINE | ID: mdl-38906747

ABSTRACT

ABSTRACT

BACKGROUND:

The revised American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) for splenic injury incorporates radiologic features but the implications of this are unknown. We hypothesized that the revised AAST-OIS would better predict outcomes.

METHODS:

Patients with a blunt splenic injury admitted to a Level I trauma center were reviewed from 2016 to 2021. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for splenectomy were calculated for high-grade injuries (AAST-OIS grades IV-V) using both schemas.

RESULTS:

Of the 852 patients analyzed, 48.5% were observed, 24.6% were embolized, and the remaining underwent operative intervention. The median AAST-OIS increased from II to III (p â< â0.01). Sensitivity (38.0% vs. 73.7%) and NPV (80.9% vs. 88.2%) for splenectomy increased for high-grade injuries but specificity (93.5% vs 70.1%) and PPV (67.5% vs 46.7%) decreased.