INTRODUCTION: Nonoperative management (NOM) of hemodynamically stable high grade (IV-V) blunt @entity130 (BST) remains controversial given the high failure rates (19%) that persist despite angioembolization (AE) protocols. The NOM protocol was modified in 2011 to include mandatory AE of all grade (IV-V) injuries without CB along with selective AE of grade (I-V) with CB. The purpose of this study was to determine if this new AE protocol significantly lowered the failure rates for grade (IV-V) injuries allowing for safe observation without surgery and if the exclusion of grade III injuries allowed for the prevention of unnecessary angiograms without affecting the overall failure rates. METHODS: The records of @entity1 with BST from January 2000 to October 2014 at a Level I @entity130 center were retrospectively reviewed. @entity1 were divided into two groups and failure of nonoperative management (FNOM) rates compared: New AE (NAE) protocol (2011-2014) with mandatory AE for all grade (IV-V) injuries without CB and selective AE for grade (I-V) with CB vs. Old AE (OAE) protocol (2000-2010) with selective AE for grade (I-V) with CB. RESULTS: 712 @entity1 underwent NOM with 522 (73%) in the OAE group and 190 (27%) in the NAE group. Evolving from the OAE to the NAE strategy resulted in a significantly lower FNOM rate for the overall group (grade I-V) (OAE vs. NAE, 4% to 1%, p=0.04) and the grade (IV-V) group (OAE vs. NAE, 19% vs. 3%, p=0.01). Angiograms were avoided in 113 grade (I-III) injuries with no CB; these @entity1 had NOM with observation alone and none failed. CONCLUSIONS: A protocol utilizing mandatory AE of all high grade (IV-V) injuries without CB and selective AE of grade (I-V) with CB may provide for optimum salvage with safe NOM of the high grade injuries (IV-V) and limited unnecessary angiograms. p.

To nearly come full circle: Nonoperative management of high-grade IV-V blunt XXXX is safe utilizing a protocol with routine angioembolization.

@entity1 :: ('9606', 'Species') :: ['patients', 'Patients'] @entity130 :: ('MESH:D014947', 'Disease') :: ['trauma', 'splenic trauma']
@entity130 :: (MESH:D014947,Disease) :: ['splenic trauma']
