HCA Florida Lake Monroe Hospital: Blunt Splenic Injury

This enduring material is designed to educate the learner on best trauma practices keeping multidisciplinary fields in mind using discussion and clinically relevant patient presentations.

1. Evaluate opportunities to improve standards of care, treatment errors and how to avoid those errors in practice.
2. Examine a succinct overview of a patient's condition and/or complications then analyze corresponding literature.
3. Propose and participate in evidence-based initiatives within the trauma population.

Publication Dates:

Release Date: December 8, 2025

Expiration Date: December 8, 2027

Bibliography:

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• Albreiki M, Voegeli D. Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: a systematic review. Eur J Trauma Emerg Surg. 2018 Apr;44(2):191-202. doi: 10.1007/s00068-017-0862-y. Epub 2017 Oct 27. PMID: 29079917; PMCID: PMC5884894.

• Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, del Junco DJ, Brasel KJ, Bulger EM, Callcut RA, Cohen MJ, Cotton BA, Fabian TC, Inaba K, Kerby JD, Muskat P, O'Keeffe T, Rizoli S, Robinson BR, Scalea TM, Schreiber MA, Stein DM, Weinberg JA, Callum JL, Hess JR, Matijevic N, Miller CN, Pittet JF, Hoyt DB, Pearson GD, Leroux B, van Belle G; PROPPR Study Group. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015 Feb 3;313(5):471-82. doi: 10.1001/jama.2015.12. PMID: 25647203; PMCID: PMC4374744.

• Kasotakis, George MD; Sideris, Antonis MD; Yang, Yuchiao PhD; de Moya, Marc MD; Alam, Hasan MD; King, David R. MD; Tompkins, Ronald MD, ScD; Velmahos, George MD, MsEd, PhD the Inflammation and Host Response to Injury Investigators. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: An analysis of the Glue Grant database. Journal of Trauma and Acute Care Surgery 74(5):p 1215-1222, May 2013.

• Avery P, Morton S, Tucker H, Green L, Weaver A, Davenport R. Whole blood transfusion versus component therapy in adult trauma patients with acute major haemorrhage. Emerg Med J. 2020 Jun;37(6):370-378. doi: 10.1136/emermed-2019-209040. Epub 2020 May 6. PMID: 32376677.

• Ngatuvai M, Zagales I, Sauder M, Andrade R, Santos RG, Bilski T, Kornblith L, Elkbuli A. Outcomes of Transfusion With Whole Blood, Component Therapy, or Both in Adult Civilian Trauma Patients: A Systematic Review and Meta-Analysis. J Surg Res. 2023 Jul;287:193-201. doi: 10.1016/j.jss.2023.02.010. Epub 2023 Mar 20. PMID: 36947979.

• Dorken-Gallastegi A, Spinella PC, Neal MD, Leeper C, Sperry J, Peitzman AB, Brown JB. Whole Blood and Blood Component Resuscitation in Trauma: Interaction and Association With Mortality. Ann Surg. 2024 Dec 1;280(6):1014-1020. doi: 10.1097/SLA.0000000000006316. Epub 2024 May 6. PMID: 38708894; PMCID: PMC11538373.

• Prethika PA, Mohan G, Shastry S, Balakrishnan JM. Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes. Asian J Transfus Sci. 2024 Jan-Jun;18(1):7-15. doi: 10.4103/ajts.ajts_56_23. Epub 2024 Jun 21. PMID: 39036674; PMCID: PMC11259345.

• Sims CA, Holena D, Kim P, Pascual J, Smith B, Martin N, Seamon M, Shiroff A, Raza S, Kaplan L, Grill E, Zimmerman N, Mason C, Abella B, Reilly P. Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial. JAMA Surg. 2019 Nov 1;154(11):994-1003. doi: 10.1001/jamasurg.2019.2884. PMID: 31461138; PMCID: PMC6714462.

• Kozar, Rosemary A. MD, PhD; Crandall, Marie MD; Shanmuganathan, Kathirkamanthan MD; Zarzaur, Ben L. MD; Coburn, Mike MD; Cribari, Chris MD; Kaups, Krista MD; Schuster, Kevin MD; Tominaga, Gail T. MD. Organ injury scaling 2018 update: Spleen, liver, and kidney. Journal of Trauma and Acute Care Surgery 85(6):p 1119-1122, December 2018. | DOI: 10.1097/TA.0000000000002058

• Zarzaur, Ben L. MD, MPH; Dunn, Julie A. MD; Leininger, Brian MD; Lauerman, Margaret MD; Shanmuganathan, Kathirkamanthan MD; Kaups, Krista MD; Zamary, Kirellos MD; Hartwell, Jennifer L. MD; Bhakta, Ankur DO; Myers, John MD; Gordy, Stephanie MD; Todd, Samuel R. MD; Claridge, Jeffrey A. MD; Teicher, Erik MD; Sperry, Jason MD; Privette, Alicia MD; Allawi, Ahmed MD; Burlew, Clay Cothren MD; Maung, Adrian A. MD; Davis, Kimberly A. MD, MBA; Cogbill, Thomas MD; Bonne, Stephanie MD; Livingston, David H. MD; Coimbra, Raul MD; Kozar, Rosemary A. MD, PhD. Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial. Journal of Trauma and Acute Care Surgery 83(6):p 999-1005, December 2017. | DOI: 10.1097/TA.0000000000001597

• Byerly SE, Jones MD, Lenart EK, Seger CP, Filiberto DM, Lewis RH, Kerwin AJ, Magnotti LJ. Serial CT for Nonoperatively Managed Splenic Injuries. Am Surg. 2022 Jul;88(7):1504-1509. doi: 10.1177/00031348221082285. Epub 2022 Mar 28. PMID: 35341346.

• Smith, Jason MD; Armen, Scott MD; Cook, Charles H. MD; Martin, Larry C MD. Blunt Splenic Injuries: Have We Watched Long Enough? The Journal of Trauma: injury, infection, and critical care 64(3):p 656-665, March 2008. DOI: 10.1097/TA.0b013e3181650fb4

• Lamb T, Lenet T, Zahrai A, Sha JR, McLarty R, Shorr R, Le Gal G, Glen P. Tiing of pharmacologic venous thromboembolism prophylaxis initiation for rauma patients with nonoperatively managed blunt abdominal solid organ injury: a systematic review and meta-analysis. World J Emerg Surg. 2022 Apr 25:17(1):19. DOI: 10.1186/s13017-022-00423-1.

• Alejandro KV, Acosta JA, Rodriguez PA. Bleeding manifestations after early use of low-molecular-weight-heparins in blunt splenic injuries. Am Surg. 2003 Nov;69(11):1006-9. PMID: 14627266.

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• Schnuriger B, Inaba K, Konstantinidis A, Lustsenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery emboliation after trauma: a systematic review and meta-analysis. J Trauma. 2011 Jan;70(1):252-60, doi: 10.1097/TA.0b013e3181f2a92e.

• Podda M, De Simone B, Ceresoli M, Virdis F, Favi F, Wiik Larsen J, Coccolini F, Sartelli M, Pararas N, Beka SG, Bonavina L, Bova R, Pisanu A, Abu-Zidan F, Balogh Z, Chiara O, Wani I, Stahel P, Di Saverio S, Scalea T, Soreide K, Sakakushev B, Amico F, Martino C, Hecker A, de'Angelis N, Chirica M, Galante J, Kirkpatrick A, Pikoulis E, Kluger Y, Bensard D, Ansaloni L, Fraga G, Civil I, Tebala GD, Di Carlo I, Cui Y, Coimbra R, Agnoletti V, Sall I, Tan E, Picetti E, Litvin A, Damaskos D, Inaba K, Leung J, Maier R, Biffl W, Leppaniemi A, Moore E, Gurusamy K, Catena F. Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document. World J Emerg Surg. 2022 Oct 12;17(1):52. doi: 10.1186/s13017-022-00457-5. PMID: 36224617; PMCID: PMC9560023.

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HCA Healthcare is committed to providing CME that is balanced, objective, and evidence-based. In accordance with the ACCME Accreditation Requirements and Standards, all parties involved in content development are required to disclose all financial relationships with ineligible entities (commercial interest).  All relevant financial relationships have been mitigated prior to the commencement of the activity.