Blunt trauma induced splenic blushes are not created equal

During a 10-year period, we reviewed all patients transferred with blunt splenic injuries and contrast extravasation on initial postinjury CT scan.During the study period, 241 patients were referred for splenic injuries, of whom 16 had a contrast blush on initial CT imaging (88% men, mean age 35 ± 5, mean ISS 26 ± 3). Eight (50%) patients were managed without angioembolization or operation. Comparing patients with and without intervention, there was a significant difference in admission heart rate (106 ± 9 vs 83 ± 6) and decline in hematocrit following transfer (5.3 ± 2.0 vs 1.0 ± 0.3), but not in injury grade (3.9 ± 0.2 vs 3.5 ± 0.3), systolic blood pressure (125 ± 10 vs 115 ± 6), or age (38.5 ± 8.2 vs 30.9 ± 4.7). Of the 8 observed patients, 3 underwent repeat imaging immediately upon arrival with resolution of the blush. In the intervention group, 4 patients had ongoing extravasation on repeat imaging, 2 patients underwent empiric embolization, and 2 patients underwent splenectomy for physiologic indications.For blunt splenic trauma, evidence of contrast extravasation on initial CT imaging is not an absolute indication for intervention. A period of observation with repeat imaging could avoid costly, invasive interventions and their associated sequelae.A contrast blush on computed tomography (CT) scan has been identified as a risk factor for failure of nonoperative management (NOM) of splenic injuries [1-3], prompting many centers to perform routine splenic artery angioembolization in the presence of a blush [4,5]. Using evidence of contrast extravasation on CT scan as an indication for angioembolization, however, has never been subjected to rigorous analysis. In our experience, patients with splenic injuries transferred from other institutions specifically for angioembolization have often resolved the blush upon repeat imaging at our hospital. This made us question whether all postinjury splenic blushes were equivalent. Is evidence of contrast blush a mandate for